ACH Authorization Form I hereby authorize Lawton Academy (THE COMPANY) to initiate entries to my (our) checking/savings accounts at the financial institution listed below (THE FINANCIAL INSTITUTION) and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until THE COMPANY is notified by me (us) in writing to cancel it in such time as to afford THE COMPANY and THE FINANCIAL INSTITUTION a reasonable opportunity to act on it. Name of Financial Institution(required) Warning Address of Financial Institution – Branch, City, State, & Zip(required) Warning Signature(required) Warning Date(required) Warning Name(required) Warning Student Name(s)(required) Warning Address(required) Warning Set Amount (Divide your total bill by ten): Warning or Maximum Amount: Warning Financial Institution Routing Number(required) Warning Checking/Savings Account Number(required) Warning Warning. SubmitSubmitting form
