Agreement for Automated Clearing House (ACH) Services Please enable JavaScript in your browser to complete this form.I hereby authorize Santa Fe School for the Arts & Sciences, hereinafter called COMPANY, to initiate debit entries and, if necessary, credits and adjustments for any debit entries in error to my account indicated below and the depository named below, hereinafter called DEPOSITORY, to debit and/or credit the same to such account. *New Sign-upContinuationChange AccountSelect a service optionName of Account Holder *FirstMiddleLastEmail *Student Name(s) *Please include siblings if applicableSelect Account *CheckingSavingsAccount # *Transit/ABA # *Select Payment Option *5th of the Month20th of the MonthBank/Financial InstitutionNameBranchAddressAddress Line 1CityNMAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateDate Debit Ends:Date Debit Begins:Signature *Clear SignatureThis authority is to remain in full force and effect for the dates shown above or until COMPANY has received written notification from me of its termination in such time and in such manner as to afford COMPANY a reasonable opportunity to act on it.Date *Please upload a voided check here if a checking account is selected Click or drag files to this area to upload. You can upload up to 2 files. Submit
