ACH Direct Payment Authorization Form
I am:
a new automatic payment applicant
a current automatic payment user reporting a change in my bank/credit union account number
Property Name
Account Number
Personal Information:
First Name: Last Name:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Checking or Savings Account Debits - ACH (Recurring Payments FREE)
Debit Date: All drafts will be made on the 1st of the month.
Bank Routing/Transit #
Bank Account Number
Name of Financial Institution
Name(s) on Bank Account
Recurring Debit Amount $
Start Date
         I understand that should my bank dishonor my authorized payment for insufficient or uncollected funds, the original amount plus an additional transaction in the amount of the state allowed NSF check fee may be electronically debited from my account.
         I hereby authorize periodic payment(s) from my account as designated to be paid to Paradise Property Manaagement in payment for services rendered to me as agreed above as well as authorizing us to withdraw a higher amount automatically when assessments are increased.
Should I need to revoke this authorization, I may call Paradise Property Management at least five days before the payment due date at (435) 123-4567 during normal working hours.

If I cancel within the first 12 months a fee of $9.95 will be applied. This does not apply to a resale of a property.

By clicking "Continue" you are agreeing to the above terms and conditions.
Payment Information
Method of Payment:
Update name from Personal Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Personal Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
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