Date:

ACH Recurring Payment Authorization

Automatic bank draft — easier for everyone. No more checks or due-date reminders.

Your rent will be automatically deducted from your checking or savings account. Please complete and sign this form.

Recurring payments make your life easier: they're convenient (saving you time and postage), and your payment is always on time — even if you're out of town — eliminating late charges.

How it works: you authorize regularly scheduled charges to your bank account on the schedule below. A receipt for each payment can be emailed to you, and the charge will appear on your bank statement as an "ACH Debit." No prior notification is provided unless the date or amount changes, in which case you will receive notice at least 10 days before the payment is collected.

I, , authorize to initiate automatic electronic funds transfer (ACH debit) entries from my bank account on the 1st day of each month for payment of rent at the property below.

Tenant & Property

Property Address:

Current Monthly Rent:

First Draft Date: (mgmt completes)

Bank Account Information

Account Type: Checking Savings

Name on Account:

Bank Name:

Routing Number (9 digits):

Account Number:

Bank City / State:

Please attach a voided check or a bank letter confirming the account details.

Authorization Terms

This authorization remains in effect until I cancel it in writing, and the company named above has had reasonable time to act on the cancellation (minimum of 10 business days). I agree to provide written notice of any change to my account information at least 15 days before the next billing date. Any change to my monthly rent amount will be provided to me in writing at least 30 days before it takes effect. If a scheduled draft falls on a weekend or holiday, the payment may be executed on the next business day; because this is an electronic transaction, funds may be withdrawn from my account as soon as the scheduled date. If an ACH transaction is rejected for non-sufficient funds (NSF), the landlord may at its discretion re-attempt the charge within 30 days, and I agree to a $50 charge for each attempt returned NSF, initiated as a separate transaction. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law, and I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms of this authorization. I certify that I am an authorized signer on the account listed above and that all information provided is accurate and complete.

Tenant Signature

Date

Printed Name: