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This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of it's termination in such manner as to afford COMPANY and BANK reasonable opportunity to act upon it. Name(s)_________________________
__________________________ Signature(s)______________________ __________________________ Association___________________________________________________ Daytime Phone Number_________________________________________ Date___________________________ Homeowners
Association Account Number__________________________ **Please note** To insure accuracy, please attach a void or canceled check from the account identified above. You will receive a letter confirming the date we will begin to pay your assessments by ACH Debit prior to the first charge. To expedite your new ACH Debit set up you may mail this application, with a void check to P. O. Box 4498, Santa Ana, CA 92702-4498 or FAX it to (714) 647-9393.
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