I created this form for our tenants to authorize accounting to draft their accounts for rent each month.

1. Office use only
Property:_______________
Account#:_______________
Recurring ACH Authorization Form
In order for us toaccept and billyour bankaccount,please completethe following:
 Prov ide information for ALLfields in the form below;
 SIGN and DATE this form;
 Mail this form to255N. Center St Suite 200
Attn: Lease Administrator
Arlington,TX 76011
Contact/Billing Information as shown on bank account:
Company: Contact Name:
Address: City:
State: Zip Code:
Phone: Email:
Bank Name Billing Zip Code
Routing Number Account number
Total Monthly Rent: $ Amount tobe charged each month:$
RECURRING BILLING: I hereby authorize ColdwellBanker Commercial AllianceDFW (CBC Alliance) tocharge
the above indicated bankaccount in the above indicated amount, for my monthly Rent,CAM,Electric,Insurance,
and/or Taxes on a recurring basis. Iagreethat this charge will be made on the first day of each month of service
for the duration of my lease agreement. If I wish toterminate the Recurring Billing process, Imust notify CBC
Alliance inwriting, of the cancellation. CBC Alliance will discontinue the Recurring Billing process upon receipt of
my written notice.
Authorization:Ihereby authorize CBC Alliance todebit my above stated bankaccount on a Recurring Billing basis. I
will not dispute CBC Alliance recurring billing with my banksolong as the amount in question was for service
rendered prior tomy cancelling my account in the manner required.Ifurther agree that if Ihave any problems or
question regarding my CBC Allianceservice,Iwill contact CBC Alliance for assistance at 817-226-0000.
I guaranteeand warrant that Iam thelegalaccountholder of this bankaccount,and that Iam legally authorized to
enter intothis recurring billing agreement with CBC Alliance.
Accountholder Signature Date
Accountholder Name Printed