AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)
BGL dba Suburban Garbage Service Address:
6075 State Street Salem, OR 97317
I (We) hereby authorize Suburban Garbage
Service , here after called
COMPANY,
to initiate debit entries to my (our) 
Checking Account/ Savings Account
(select one)
indicated below at the depository financial institution named below,
hereafter called
DEPOSITORY, and to debit the same such account. I (we) acknowledge that
the origination of
ACH transactions to my (our) account must comply with the provisions of
US law.
Depository Name
Branch
City
State
Zip
Routing Number
Account
Number
This authorization is to remain in full force and effect until
Suburban Garbage has received
written notification from me (or either of us) of its termination in
such time and in such manner
as to afford Suburban Garbage and DEPOSITORY a reasonable opportunity
to act on it.
Name(s)
Account Number
Date
Signature
NOTE: ALL DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE
RECEIVER
MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR
IN THE MANNER SPECIFIED IN THE AUTHORIZATION.
