Electronic Check Authorization Form
Please email back to us at peakfingroup@gmail.com or in copy/paste in contact us
Please complete the information below to authorize an electronic check payment (ACH-debit)
Name on Check: _________________________________________________________
Address: Street ____________________________________________________
City ________________________State ______________Zip________
Bank Name ___________________________________
Bank Routing Number ___________________________________
Bank Account Number ___________________________________
Type of Account: Checking
Amount Authorized: $_______________ for one time debit
Signature: _____________________________________________________