Debit Your Account, One Time Authorization


Dear Sir or Madam:

You are authorized and directed to debit our Account, named ____________, with our Account number: ______________, for $ ___________ for a one time payment, payable payable to: _________________ (Name), at _____________ (Bank), with account number ________________ and ABA Routing Number _________________. Please charge our account any fees to accomplish this transaction.

This shall be your good and sufficient authority for doing so.

Best regards,

Authorized Signer of Account
cc Recipient of debit