Authorization Agreement for Preauthorized Payment

Customer Name(s):

Customer Account #:

Email Address:

I (we) hereby authorize Frontier Cooperative hereinafter called COMPANY, to initiate credit/deposit entries to my (our)
Select one:

checking Savings account

indicated below, hereinafter called CUSTOMER, to credit/deposit same to same such account

Depository Name:

Branch:

Address:

City:

State:

Zip Code:

Transit/ABA Number:

Account Number:

This authority is to remain in full force and effect until COMPANY and CUSTOMER has written notification from me (us) of its termination in such time and in such a manner as to afford COMPANY and CUSTOMER a reasonable opportunity to act on it.

Name:

Signature:

Name:

Signature:

Please indicate any liens against the crops here:

None Yes, please attach separate sheet listing lien holder(s) name, address and phone number.

Date:

Now

***A voided check must accompany this form in order for it to be complete. If a voided check is not available, then either a bank specification sheet or a letter on the bank’s letterhead confirming the ABA and bank account number is required.

Frontier Cooperative, 4665 Innovation Drive Lincoln, NE 68521 Phone number: 402-937-1800