ACH Authorization

Authorization Agreement for Direct Payments (ACH Debits/Credits)

Complete the form below to authorize Boyd & Boyd, Inc. to initiate a one-time ACH payment from the bank account provided.

A $15.00 ACH Service Charge will be added to the payment amount.

Client Information

Name on Account *

Customer Address *

City *

State *

ZIP Code *

Phone Number *

Email Address *

Bank Account Information

Bank Name *

Bank Routing Number *

Bank Account Number *

Account Type *

Checking

Savings

Transaction Information

Transaction Type: One-Time Payment Only

Payment Amount *

ACH Service Charge: $15.00 — A $15.00 ACH Service Charge will be added to the amount authorized above.

Authorization

I hereby authorize Boyd & Boyd, Inc. to initiate a one-time ACH debit from my account indicated above at the financial institution named above for the amount listed above plus a $15.00 ACH Service Charge. This authorization is for Debit Only — Payment to Boyd & Boyd, Inc. I acknowledge that the origination of ACH transactions to my account must comply with U.S. law. I understand that this authorization will remain in full force and effect until I notify Boyd & Boyd, Inc. in writing at least 10 business days in advance to terminate the authorization.

I have read and agree to the ACH Authorization above and authorize Boyd & Boyd, Inc. to initiate the one-time payment described in this form.

Signature

By typing my full name below, I understand that I am providing my electronic signature and agreeing to the authorization stated above.

Customer Signature / Typed Full Name *

Date *

Please review all information carefully before submitting.

Your Financial Information

Please make sure all banking information is entered accurately before submitting your authorization. If you have questions about submitting earnest money by ACH, please contact Boyd & Boyd, Inc.