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ACH CREDIT/DEBIT AUTHORIZATION FORM
*
Indicates required field
Name
*
First
Last
Email
*
example@website.com
Name of Financial Institution
*
Address of Financial Institution
*
Financial Institution Routing #
*
These numbers are located on the bottom of your check.
Checking/Savings Account #
*
These numbers are located on the bottom of your check.
Check Box to Confirm
*
I hereby authorize Stevens Management LLC to initiate entries to my checking/savings accounts at the financial institution listed above and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until Stevens Management LLC is notified by me in writing to cancel it in such time as to afford Stevens Management LLC and my financial institution a reasonable opportunity to act on it.
Comments/Special Instructions
*
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