FAX TO: C.Taylor 281-445-7257

CHECKING ACCOUNT CHANGE FORM

Please complete this section and attach a signed voided check to designate the account number to which your Visa/MasterCard transactions fees should be credited and debited

___________________________________   _______________________________________
Name of Deposit Bank                                         Address


 

The undersigned is authorized to sign on behalf of the entity named below. Upon receipt of this document, please administrate the checking account change. I am aware the process usually takes 5 business day to complete. To expedite the request please fill out the form below.

Company Name: _________________________________________MID________________________

Authorized Signature: _X__________________________________Title___________

Name (please print)  _____________________________________ Date: __________


The changes to the checking account that are the merchant responsibilities are:

Amex : 800-528-5200 ext. 0
Discover: 800-347-2000 ext. 0
Telecheck: 800-733-1132
Authorize Net: 801-818-3311