ACH Transfer Authorization Form ACH Transfer Authorization Form "*" indicates required fields Bank Transfer Authorization FormConsent* I agree to these termsI authorize Mason's Propane Service LLC to electronically debit my bank account according to the terms outlined below. I acknowledge that electronic debits against my account must comply with United States law. Mason's Propane Service is not responsible for any overdrafts or overdraft fees caused by the automatic draft.Terms of billing:* One Time Payment Monthly Payment with my amount specified Monthly Payment with amount due and accordingly thereafter Amount due immediately when billed. Run amount owed on the due date One time payment on* MM slash DD slash YYYY When do you want the payment to post?for the amount of $*Starting on* MM slash DD slash YYYY and on the*day of the monthof each month through* MM slash DD slash YYYY for the amount of $*Starting on* MM slash DD slash YYYY for amount due and accordingly thereafter per the terms in invoice(s).Starting on* MM slash DD slash YYYY for amount due immediately when billed.Customer bank account information*Routing NumberAccount Number Add RemoveRouting Number & Account Number fields will be encryptedAccount Type* Checking Savings Consumer Business Consent* I agree to these termsThis payment authorization is to remain in effect until I notify Mason's Propane Service LLC., of its cancellation by giving written notice in enough time for the business and receiving financial institution to have a reasonable opportunity to act on it.Customer Name* First Last Today's Date MM slash DD slash YYYY Customer Account NumberThis field will be encryptedEmail Not Required, if email is entered, we will send you an email confirmation of this form.
