EFT AUTHORIZATION
INSTRUCTIONS: Complete the form below and attach an unsigned and voided
check from
this account to assist in verifying data.
The
undersigned authorizes Apex Oil Company, Inc. hereafter called
"Company" to
initiate
debit entries to the account indicated below.
In the event an error is made, the
undersigned
authorizes the financial institution named below, hereafter called
"Institution",
to credit the amount of such error to the account below.
This
authority is to remain in full force and effect until revoked by the
undersigned. Any
revocation
is effective only after Company has received written notice from the
undersigned
to terminate this agreement in such time and manner to afford a reasonable
opportunity
to act prior to charging the account.
COMPANY
NAME______________________________________________________
ADDRESS____________________________________________________ญญญญ__________
CITY, STATE,
ZIP_______________________________________________________
PHONE
NUMBER___________________CONTACT___________________________
FAX FOR
NOTIFICATION________________________________________________
BANK
NAME___________________________________________________________
BANK
ADDRESS________________________________________________________
BANK ACCOUNT
NO.___________________ROUTING NO.____________________
BANK PHONE
NO._______________BANK CONTACT________________________
AUTHORIZED
SIGNATURE_______________________________________________
BUSINESS
TITLE______________________DATE_____________________________