Authorization:I authorize Aging Gracefully to initiate debit entries to my (our) [checking/savings] account indicated above at the depository financial institution named above, hereinafter called Depository, to debit the same to such account. I acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

 

Amount:I authorize Aging Gracefully to debit my account for the amount of variable amounts based on the bills received on by the 3rd of the month. I understand that withdrawals will be made monthly on the 6th of the month.

 

Effective Date:This authorization will remain in full force and effect until I notify Aging Gracefully in writing of its termination in such time and in such manner as to afford Aging Gracefully and Depository a reasonable opportunity to act on it.