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Text File  |  1995-03-05  |  1KB  |  36 lines
  1. - = - = - = - = - = - = Pre-Authorized Release = - = - = - = - = - = -
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  5. This document is used to certify that ______________________________
  6. has the right to used pre-authorizd checks as a method of receiving a 
  7. regular payment of $ ____________ on the ________ day of each ________ 
  8. periods for __________ consecutive __________, beginning with the first 
  9. payment on ____/____/199__.  The pre-authorized check will be drawn my
  10. the account identified below.
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  14. Signature ___________________________________ Date: ____________
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  20.               ┌─────────────────────────────────────────────────┐
  21.               │                                                 │
  22.               │                                                 │
  23.               │                                                 │
  24.               │                                                 │                                                 │
  25.               │           Please attach a voided check          │
  26.               │               or deposit slip here.             │
  27.               │                                                 │
  28.               │                                                 │
  29.               │                                                 │
  30.               │                                                 │
  31.               │                                                 │
  32.               └─────────────────────────────────────────────────┘
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