Apply for ACH Auto-Pay – Fishers Disposal LLC

ACH Auto-Pay Application

Use this form to sign up for ACH Automatic Payments with Fisher’s Disposal

DISCLAIMER

I (we) hereby authorize Fisher's Disposal, LLC., hereinafter called “FISHER'S”, to initiate electronic debit entries to my (our) account indicated below and the financial institution named below to debit the same to such account for the purpose of Garbage and Recycling Removal using Auto-pay. I (we) acknowledge that ACH transactions I (we) authorize must comply with all applicable laws, including U.S. law. In the event of an erroneous or duplicate entry, I hereby authorize FISHER'S to credit my account indicated below to correct any error made.

Name *Your name, or name of business

Email AddressEmail address we can contact you at

PhonePhone number we can contact you at

Financial Institution *Financial Institution you'd like to enroll with

BranchBranch number or location

Street AddressAddress of Financial Institution

City

State/Province

ZIP / Postal Code

Routing Number *

Account Number *

Account Type *Choose between Checking or Savings

Consent *

I agree to be ACH auto-debited for the amount owed to FISHER'S for disposal and/or recycling service each month. I understand that my bill, and accordingly, my ACH debit, may vary from month to month.

NOTE

*If the debit is recurring and the date of the debit falls on a non-banking day, the debit may post to your account on the next banking day and will not post to your account prior to the authorized date

This authorization is to remain in full force and effect until FISHER'S has received written notification from me of its termination in such time and manner as to afford FISHER'S a reasonable opportunity to act on it.

Signature *

Start signing your signature here

DateToday's date