Auto-Draft Authorization Form

 Thank you for taking advantage of our no cost Automatic Draft program for your association assessment (dues) payments. There are several important items that we ask that you consider before submitting your completed form.

• Your account will be drafted between on the 5th day of the month.
• You MUST include a voided check with your completed form – we cannot process deposit tickets of any sort.
• Your completed auto-draft authorization form and voided check must be received by the 25 of the month before the start date of your draft.
• Your account will continue to be drafted until written (email is acceptable) notification is submitted. 
 AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS
(ACH DEBITS)
NOTE: A VOIDED CHECK MUST BE ATTACHED TO THIS FORM TO BE PROCESSED PROPERLY
I (we) hereby authorize CSI Property Management, hereinafter called “Company,” to initiate debit entries to my (our) _____ Checking Account or _____ Savings Account (select one) indicated below at the depository financial institution named below, hereinafter called “Depository,” and to debit the same to such account for the purpose of collecting assessments for my community association. I (we) understand that this DEBIT WILL OCCUR ON OR ABOUT THE 5TH OF EACH MONTH in which assessment payments are due. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of United States law.
Depository Name: ______________________________________ Branch: _______________________
City: _______________________________________ State: _______________ Zip: ¬¬¬¬¬_______________
Routing Number (9 digits): ________________________ Account Number: ______________________
This authorization is to remain in full force and effect until Company has received written notification from me (or either of us) of its termination in such time, and in such manner, as to afford Company and Depository a reasonable opportunity to act on it.

My Association is: ___________________________________

Name: _____________________________________________ My Account #: __________

Unit Address: _______________________________________________________________________

Hone Phone: _______________________________ Cell: _____________________________

Email Address: _____________________________________________

Signature(s): ______________________________________ ______________________________________

Printed Name (s): _________________________________ ______________________________________

Date: _______________________________ My Start Date: _________________________________

Paperwork must be received by the 25th of month preceding the start of the draft.

PLEASE RETURN FORM AND VOIDED CHECK TO:
CSI Property Management, P.O. Box 4810, Davidson, NC 28036

NOTE: A VOIDED CHECK MUST BE ATTACHED TO THIS FORM TO BE PROCESSED PROPERLY

Check:





Management Company Use Only:
Owner Account Number:
ACH FORM