AUTHORIZATION FOR DIRECT PAYMENT 


I authorize IDEAL MOVERS & STORAGE, INC. to initiate debit entries to my checking/savings account.  This authority will remain in effect until I notify you in writing to cancel it in such time as to afford the company a reasonable opportunity to act on it.

 

                                                                                                                                                           

(NAME OF FINANCIAL INSTITUTION)                                                                                 (BRANCH)

 

                                                                                                                                                                                                  

(CITY)                                                                                             (STATE)                              (ZIP CODE)

 

                                                                                                                                                                                                  

(NAME AS IT APPEARS ON YOUR ACCOUNT - PLEASE PRINT)

 

                                                                                                                                                                                                  

(SIGNATURE)                                                                                                                            (DATE)

 

Monthly payment amount: $                                                    Regular payment date                                

Unit #:                                                   

                                                                   Checking           or                 Savings     
                                     

:

 

 

 

 

 

 

 

 

 

:

TRANSIT ROUTING NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


                                                                                           ACCOUNT NUMBER INFORMATION

PLEASE ATTACH VOIDED CHECK AND MAIL TO:

IDEAL MOVERS & STORAGE, INC.
P.O. BOX 597
HADLEY, MA 01035