ACH Authorization

Customer's Name*
I (we) hereby authorize Mulgrew Oil Co., hereinafter called Company, to initiate Debit Entries to my (our) Checking Account indicated below at the depository financial institution named below, hereinafter called Depository, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.
Depository (Name of Your Bank)
Bank Name*
Branch*
City*
State*
Routing Number*
Account Number*
This authorization is to remain in full force and effect until Company has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it.
Name(s) on account*
FED ID Number
If Applicable
Signature*
Date*
MM slash DD slash YYYY
Note: All written debit authorizations must provide that the receiver may revoke the Authorization only by notifying the Originator in the manner specified in the authorization.
Check*
Max. file size: 2 MB.
Please attach a scan of a voided check.

Depository (Name of Your Bank)