I hereby authorize K3 Management Services, on behalf of my Homeowners Association named below to initiate debit entries to my Checking / Savings Account indicated below at the depository financial institution named below, hereafter called ‘BANK’, and to debit or credit the same to such account.  If this item is dishonored, I authorize an additional returned check fee of $25.00 to be charged to this account.

Please provide the following information:

Name	You must be an authorized signer on this account!
Street Address
Address (cont.)
City
State
Zip/Postal Code
Work Phone
Home Phone
FAX
E-mail
Name of Homeowners Association
Account Number
Routing Number	see example below.
Amount to be Debited
Unit Address if Different from Mailing Address

Please indicate whether you want this payment to be debited:

One Time Only or Monthly until I notify you differently   

If you chose monthly, please specify the month you would like this to start

If you chose monthly, this authority is to remain in full force and effect until the Company has received written notification from the Customer of its termination in such time and in such manner as to afford the Company a reasonable opportunity to act on it.  The monthly debit will occur on the 10th of each month unless the tenth falls on a weekend or holiday in which case the debit will be performed on the next business day. 

Please initial here if you agree to the terms of this agreement and to authorize K3 Management to debit your account.