achagreement - Renk Seed

ACH/Direct Deposit Agreement Form

Vendor Name:*

Authorization Agreement

I (vendor name) hereby authorize Renk Seed Company to initiate automatic deposits to my account at the financial institution named below. I also authorize Renk Seed Company to make withdrawals from this account in the event that a credit entry is made in error.

Further, I agree not to hold Renk Seed Company responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until Renk Seed Company receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit from to Renk Seed Company.

Account Information

Name of Financial Institution:*

Name(s) on the Account:*

Routing Number:*

Account Number:*

Account Type (choose one):

Vendor Contact Information

Vendor Contact Name:*

Vendor Contact Phone Number:*

Vendor E-mail Address:*

Authorized Signature

Authorized Name:*

Date:*