ACH Payment Authorization FormStep 1 of 1

All information will remain confidential

Bank Details

I Understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Concord Feed & Fuel, Inc. in writing of any changes in my account information or termination of this authorization. For ACH debits to my checking/savings account, I understand that because these are electronic transitions, these funds will be withdrawn from my account as soon as they are requested. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account and will not dispute the transactions with my bank, so long as the transactions correspond to the terms indicated in this authorization form.