Electronic Funds Transfer Authorization Form

I/we hereby authorize PALM BEACH LAWN MAINTENANCE SERVICE, INC., to initiate EFT debit entries in the amount of $______________from my/our checking account. I also authorize additional debit entries only when I request and receive additional services such as fertilizer, mulch, plantings etc. In addition, in the future, if I am notified of a monthly rate increase I authorize the new rate to be debited without having to sign and mail a new EFT form. This authority will remain in effect until I notify PALM BEACH LAWN MAINTENANCE SERVICE, INC., otherwise at least 10 days prior to the termination date. I/we acknowledge that the origination of ACH transactions to my/our account must comply with the provisions of U.S. law.

Name of Your Bank: _____________________________________________________

The account number to be debited: #________________________________________

Your Bank’s Routing/Transit Number: ________________________________________
(9-digit number found on lower left side of check)

Account Owner’s Signature(s): _____________________________________________

                                                     ______________________________________________

Account Owner’s Name(s):

________________________________________________
(Please Print)

_______________________________________________
(Please Print)

Date first payment is to be debited from your account:
(Choose either the 1st or 20th day of the month):___________
Note: payments are applied to the service month in which they are drafted.

Date this form was signed: ________________________________
 

********** PLEASE INCLUDE A VOIDED CHECK!!! ************

Note: If you are on the fertilization schedule your fertilizing charge will be divided by 3 and included in your monthly payment so that the amount debited is the same each month. For example, if you pay $45 quarterly for fertilizer you will instead pay $15 each month.