EFT Authorization Form

Lessor:*
Lessee/Tenant Name:*
First Last
Leased Address*
Street Address City State ZIP Code
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Phone*
Bank Account:*
Bank:*
Account Name:*
Routing #*
Checking Account #*
The undersigned, being a duly authorized check signer on the financial institution account identified above, hereby authorize Pacifica Commercial Central Coast, Inc., dba Pacifica Commercial Realty (the Managing Agent for the above referenced Lessor) to perform scheduled or periodic electronic funds transfer debits from the account identified above for payments due or when applicable, associated with the above referenced property pursuant to the above referenced Lease and any subsequent addendums and/or amendments. This authorization applies to electronic payments and includes all charges and credits authorized by the Lease and shall remain in effect until revocation by the undersigned. I understand and authorize all the above as evidenced by my signature below.
Signature*
Date*
MM slash DD slash YYYY
Print Name*
Title*
CAPTCHA