## AUTOMATED CLEARING HOUSE (ACH) AUTHORIZATION FORM

## Information:

**Financial Institution**  
Name:

Remittance Address:

Remittance City: State: Zip Code:

Contact Name: Phone #: (         )

E-Mail Address:

## Banking Information:

Bank Name:

Bank Address:

Bank’s City: State: Zip Code:

Bank Contact Name: Phone #: (         )

ABA Routing #: Account #:

**Account Type**  
(please check only one)  
- Checking  
- Savings  
- GL

## Authorization:

Please sign below to confirm that you are authorizing Autobooks, Inc to begin transferring payments to the account mentioned above. All questions and requests can be sent to accounting@autobooks.co or call (313)774-2445

Signature  
(         )

Phone Number  
Title  
Date

***Additional Verification**: Previous Bank Account # *(if applicable)*:  ________________________