By filling out the form below, I (we) hereby authorize Accelerated Websites to initiate entries to my (our) checking/savings accounts at the financial institution listed below, and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until Accelerated Websites is notified by me (us) in writing to cancel it in such time as to afford Accelerated Websites and the financial institution a reasonable opportunity to act on it.

Secure ACH Form

3 + 3 =