Authorization Agreement for Draft

Authorization Agreement for Draft

"*" indicates required fields

I (we) hereby authorize 360 Community Management, on behalf of the Association, to draft against my account for the payment of Association dues on the first (1st) day of the month. I understand that this authority shall remain in full force and effective until written notification is received from you of this termination and such time and in such manner as to afford the association a reasonable opportunity to act on it. If I am notified that Association dues are going to increase, I understand that my draft will automatically increase at the time listed in the notice. This form will authorize us to withdrawal the amount of the monthly assessment ONLY from your account. Fines, late fees, legal fees, administration fees, or any other charges on your account other than the monthly assessment will be your responsibility to pay. Bank accounts are subject to a $35.00 returned item fee if the funds are not available in your account when payment is withdrawn. This signed authorization permits the Association to send me my billing statement electronically, to my email contact on file, in lieu of a mailed paper statement. PLEASE NOTE: A VOIDED CHECK OR BANK DOCUMENT SHOWING ACCOUNT NUMBER AND ROUTING NUMBER WILL NEED TO BE PROVIDED TO SET UP ANY ACH ACCOUNTS. IF ANY PROVIDED BANKING INFORMATION IS INACCURATE, ANY RETURNED PAYMENT CHARGES WILL BE THE RESPONSIBILITY OF THE LOT OWNER AND WILL BE ADDED TO THE LOT LEDGER.

This Request is for a One-Time Draft Only

Yes

If this is a request for a recurring automatic payment of your Association assessments "dues", then you would mark "NO". Only mark "YES" if you are providing authorization for a one-time only payment. After the one-time payment, this agreement will end.

For One-Time Draft ONLY- Please indicate payment amount

This field is required only when you have requested a one-time only payment. This is not required for a recurring payment request.

Name*

First Last

Name of the Subject Property's Homeowner's Association*

Property Address (within this Homeowners Association)*

Street Address Address Line 2 City State ZIP Code

Subject Property's HOA Account Number*

This can be found on your HOA billing statement, or you may call 602-863-3600 or email info@360communitymgmt.com to get this information.

Name of Financial Institution*

Account Type*

Checking

Savings

Bank Routing Number*

Bank Account Number*

You must include your full bank account # found at the bottom right hand side of your check.

Effective Date*

Please indicate the date that you would like for us to begin pulling your automatic payment.

Upload Voided Check*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 64 MB.

Click the upload button and choose either a photo of your voided check or a scanned document file of your voided check.

Signature*

Date*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

AUTHORIZATION AGREEMENT FOR DRAFT

Authorization Agreement for Draft

HOA

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