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Electronic Fund Transfer Authorization Form

Name ________________________________________________

Home Address _________________________________________ 

City/State/Zip Code _____________________________________

Home Phone __________________________________________

E-mail address _________________________________________

Business Address _______________________________________

Is this a new address?  Yes  No 

Business Phone _________________________________________

I authorize River Ratz Storage to deduct the amount indicated below each month beginning on the 1st of the current or following month after this form is processed and continuing till further notice. This authorization will remain in effect until I send written notification to both my bank and River Ratz Storage at least ten days before the next withdrawal occurs.

Signature _____________________________________________

Financial Institution Name _________________________________

Account Number ________________________________________

Routing & Transit # ______________________________________

Name of branch office ____________________________________

Address of branch office __________________________________

Starting Date (Month/Year) _________________________________

Monthly Payment Amount                                                 $____________

Number of Months for Deduction

(if specified lease duration)_________________________________

Remember:  You must enclose a voided check bearing your account number. If using your savings account, please enclose a savings deposit slip.

NOTE: Your EFT Form must be received by the 14th of the month in order to start the 1st of the following month.

Print out this form, complete it and mail to:

River Ratz Storage

Accounts Receivable

P.O. Box  TBD

Ehrenberg, Arizona     85334

If you have questions, please call (928) 923-7289 or email us at info@riverratzstorage.com if you have any questions

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