Automatic Debit Program Application

I understand that this authorization will be in effect until I notify my managing agent in writing that I no longer desire this service, allowing management reasonable time to act on my notification. I also understand that if corrections in the debit amount are necessary, it may involve an adjustment (credit or debit) to my account. I acknowledge that the transaction will occur during the first week of each month the Assessment is due. I also understand that there is a service charge per payment returned, for any reason. If two payments are returned within one year, the service will be stopped and I will be responsible for making payments on balances due. THIS AUTHORIZATION IS NONNEGOTIABLE AND NONTRANSFERABLE.

The Automatic Debit form must be received before the 15th of the month to start the draft the following month. You will receive a confirmation letter notifying you when your first automatic debit will occur. You are responsible for sending payments up until you are notified in writing that your first payment will be taken from your account.