Please complete the below online authorization form to grant Reserve Data Analyst the authorization to run the ACH Payment (digital check) for services.
I. CLIENT & REPRESENTATIVE CONTACT INFORMATION
II. BANK ACCOUNT INFORMATION
III. ACH AUTHORIZATION (check box)
I authorize Reserve Data Analyst to electronically debit the aforementioned bank account in the amount of the authorized amount entered below. I acknowledge that electronic debit against my account must comply with United States law. I authorize a one time payment in the amount of:
IV. ADDITIONAL COMMENTS (optional)
V. ATTACH VOIDED CHECK PHOTO FILE (optional)
