ACH Debit Authorization Form

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I (we) hereby authorize Entertainment31, LLC DBA Pelham RV & Boat Storage, hereinafter called COMPANY, to initiate debit entries to my (our) account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

Email *

By completing this form I am giving my approval for Entertainment31 LLC DBA Pelham RV Storage to initiate debit entries into my account on the first of every month for services provide until I notify them in writing to cancel my agreement. I understand that I must provide a 2 week notice for cancellation. *

I agree

I do not agree

Amount you were quoted to be billed to your card each month *

85.00

95.00

150.00

250.00

Other:

First Name *

Name listed on the account

Last Name *

Name listed on the account

Depository Financial Institution Name: *

Routing Number: *

Account Number: *

Account Type: *

Checking

Savings

Business or Personal Account: *

Business Account

Personal Account

Start Date: *

YYYY

Send me a copy of my responses.

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