ACH Enrollment

AUTHORIZATION FOR AUTOMATIC PAYMENTS

By submitting this form I authorize BA MARKETING & PUBLICITY, LLC to initiate debits and/or credits necessary to correct errors or to complete the following payments from MY ACCOUNT at the DEPOSITORY.

Client(Required)

Payment Description(Required)

Email For Receipts(Required)

Authorization Type(Required)

Name of Financial Institution(Required)

Bank ABA/Routing Number(Required)

Bank Account Number(Required)

Bank Account Type(Required)

Client Billing - First Name(Required)

Client Billing - Last Name(Required)

Billing Address 1(Required)

Billing Address 2

Billing City(Required)

Billing State(Required)

Billing Postal Code(Required)

Billing Country(Required)

ACH Amount Shouldn't Exceed (If Any)

Signature(Required)

Date(Required)

ACH Enrollment – BAMP

AUTHORIZATION FOR AUTOMATIC PAYMENTS