Authorization Agreement for Preauthorized ACH Debit Transfers - Dart Bank (2 Borrowers)

Borrower Tags:

• Pair of Radio Dials for Each Borrower

  • Radio 1: We Authorize

  • Radio 2: Decline Auto Pay

• Radio 1

  • 8 Text boxes

  • 2 pairs of Radio Dials (Checking and savings & Regular Payments with Escrow or Additional Principle)

    • Radio 2 for PLUS additional principal will be triggered to Text box for the Additional Principal amount. 

  • Signature, Date, and Full name Tag for Main borrower. 

• Radio 2 (Decline Autopay)

  • Signature and Date for main borrower