Check Draft Authorization Form

 

I authorize Studio 1 to initiate funds from the client checking account as indicated below and to retain this information

for future transactions which may only be authorized by the account holder as shown below. I also authorize my depository financial institution to honor these transfers.

Invoice(s) #:

 

Check #:

 

Dollar Amount Authorized:

 

Date:

 

Client Name:

 

Client Address:

 

 

 

Client City, State & Zip:

 

Client Phone #:

 

Authorized Signer On This Account:

 

Authorized Signer Email Address:

 

Bank Name:

 

Bank Address:

 

  

 

Bank City, State & Zip:

 

Bank Routing #:

 

Checking Account #:

I have read and agree to all of the terms and conditions on this page.  I certify that I am the authorized signer for this checking account. I understand this is a binding agreement between Studio 1 and the person whose name appears above and that no signature will be on the printed check.