Letter for Pre-Authorized Payment, Specific Amount
[DATE, ex. Monday, November 28, 2011]
[NAME, BANK AND ADDRESS, ex.
City, State, Pin Code]
Dear [NAME, ex. Mr. Graham],
You are hereby authorized to withdraw from the following account the amount of [AMOUNT OF PERIODIC DEBIT, ex. $5648.26] on a [PERIOD OF PAYMENT, ex. monthly, weekly] basis on the [BILLING DATE, ex. 7th day of each month]
Bank: [BANK NAME AND ADDRESS]
Bank Transit No: [BANK TRANSIT NO., ex. 4444]
Account No: [ACCOUNT NUMBER, ex. 12345678]
Bank Tel. No. [BANK TELEPHONE NO., ex. (XXX) XXX-XXXX]
Bank Contact [NAME OF BANK CONTACT, ex. Susan Smith, Manager]
This shall be your good and sufficient authority for doing so.
We are enclosing an unsigned check from the account marked “VOID”.
[NOTE: IF MORE THAN ONE SIGNATURE IS REQUIRED ON ACCOUNT, MAKE SURE BOTH BANK SIGNING OFFICERS SIGN LETTER]
For any queries, please feel free to contact me directly.
[Your Name, ex. Mark Anthony]