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I authorize DANA Properties to initiate recurring debit entries to my financial institution account indicated below for the purpose of collecting assessments for my community association. I understand that this debit will occur on or about the 10th of each month in which assessment payments are due. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of United States law. This authorization is to remain in full force and effect until DANA Properties has received written notification from me of its termination in such time, and in such manner, as to afford DANA Properties and my financial institution a reasonable opportunity to act on the termination of this agreement.
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| Name (as it appears on your bank statement): | * |
| Association Name: | * |
| Property Address: | * |
| Email Address: | * |
| Financial Institution: | * |
| Account Type: | * |
| Routing Number (9 digits): | * |
| Bank Account Number: | * |
* indicates required field
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