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I (We) hereby authorize the Bella Vista Property Owners Association, hereinafter called BVVPOA, to initiate debit entries (and credit entries, if necessary) to my (our) checking account indicated below, and I (we) request and authorize the financial institution named below to accept and honor the same and to charge the same to my (our) account. This authorization will remain in effect until the BVVPOA has received written notification from me (or either of us) of its termination in such time as to afford the BVVPOA a reasonable time to act on the termination. I (We) understand Assessments and (or) Water/Sanitation Accounts must be current to be eligible. I (we) further authorize BVVPOA to debit my (our) account for fees BVVPOA levies because of returned or unaccepted bank drafts or payment orders.
Signature:_______________________________________________________ Date:___________________
Signature:_______________________________________________________ Date:___________________
I (We) authorize the
following accounts to be paid by Automatic Bank Draft:
Sub/Blk/Lot:___________________________________ Water Account #__________________________
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IMPORTANT ******************* IMPORTANT *******************
IMPORTANT ******************* You must attach an unsigned voided check. Please do not send a deposit slip. This authorization must be received by the 7th of the month to be effective the same month.
02/01/2005 |
