Unit #: Bldg #:

Authorization Agreement for Direct Payment
(ACH Debits)

I (we), hereinafter Resident, authorize to initiate debit entries to my (our) Checking Savings account (select one) indicated below at the depository financial institution named below, hereinafter called Depository, and to debit the same to such account. Resident acknowledges that the amount of the recurring debit entry to his/her account may vary from time to time. Resident agrees that no notification will be delivered to him/her in regard to this variance unless the transaction exceeds . Resident acknowledges that the debit will occur on or after the 1st day of each month.

Depository Name: Branch:

City: State: Zip:

Routing Number: Account Number:

This authorization is to remain in full force and effect until has received written notification from Resident of its termination within days of next withdrawal.

If the debit fails to occur due to Resident's insufficient fund account balance, or other acts of Resident to prevent payment to , Resident will be liable for all late fees and charges as outlined in Lease Agreement.

Resident agrees to indemnify and hold Mark-Taylor Residential, and all ownership entities of harmless from any and all claims and /or damages related to the authorized withdrawal from Resident's depository account(s).

Note: All written debit authorizations must provide that the receiver may revoke the authorization only by notifying the Resident in the manner specified in the above.



(Resident) Date
(Mark-Taylor Residential, Inc. / Subagent for Owner) Date