Authorization Agreement for Automatic Deposits
 (ACH Credits)

Originating Company Name:  North Georgia Technical College

I authorize the above named Originating Company to initiate entries to the account indicated below as follows:
  1. They may initiate CREDIT entries, which moves money into my account according to the schedule and other conditions to which the Originating Company and I have agreed.
  2. They may initiate DEBIT entries to reverse any transactions they have originated to my account in error.
Name(s): 
 
Student Id Number OR Social Security Number: 
 
City:   State:        Zip:
 
Home Phone:           Cell Phone: 
  
Email address: 
 
Name of Depository Financial Institution:
 
Bank Routing Number: 
 
Checking Account Number:
 
 
Please staple a VOIDED CHECK below.*
 
This authority is to remain in effect until the Originator has received written notification of its termination and has had a reasonable opportunity to act upon it.
 
 
Signed:  ____________________________________
 
Date:  May 17, 2012
 
 * DO NOT USE A DEPOSIT SLIP.  Many banks print internal transaction codes instead of their routing and transit numbers on their deposit slips.  Using an invalid routing and transit number will prevent your transaction from being directed to the correct bank, resulting in delays in the posting of your payment.

Print and mail signed form and voided check to: North Georgia Technical College, ATTN: Cashier, P.O. Box 65, Clarkesville, GA 30523 or give to cashier on any NGTC campus  
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