Dear Sir or Madam:
You are authorized and directed to debit our Account, named ____________, with our bank account number: ______________, for $ ___________ for a monthly payment to be made on the 15th day of each any every month until you are notified otherwise in writing, the payment being 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.
Authorized Signer of Account
cc Recipient of debit