Submit Direct Payment Authorization
Note: A COPY OF A VOIDED CHECK MUST BE ATTACHED TO THIS FORM TO BE PROCESSED PROPERLY
I (we) authorize
Marina or Club
to initiate debit entries indicated below at the depository financial institution named below, herinafter called "Depository" and to debit the same to such account for the purpose of collecting dues. I (we) understand that this debit will occur on or about the
of each month in which payments are due. I (we) acknowledge that the origination of the ACH transactions to my (our) account must comply with the provisions of United States law.
Copy of Voided Check
By my electronic signature, this authorization is to remain in full force and effect until Company has received written notification for 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.