direct draft authorization agreement

Company Name:	Driftwood Park Country Club		Company ID #:
I hereby authorize Driftwood Park Country Club (DPCC) to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any error to my (select one) checking or savings account at the depository financial institution named below. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U. S. law.
Depository Financial Institution Name:
Branch:
City:				State:	Zip:
Routing #:
Account #:
IMPORTANT: Attach a VOIDED check for the above referenced account to this form.
This authorization is to remain in full force and effect until DPCC has received written notification from me of its termination in such time and in such manner as to afford DPCC and DEPOSITORY a reasonable opportunity to act on it.
Name:
		(Please Print.)
Signature:
Date: