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
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PLEASE ATTACH VOIDED CHECK AND MAIL TO:
IDEAL MOVERS & STORAGE, INC.
P.O. BOX 597
HADLEY, MA 01035