For your convenience, the
Land Baron
Check-O-Matic Service
I (we) hereby authorize First
Commercial Bank on behalf of The Land Trust of Huntsville & North Alabama to
initiate fund transfers from my (our) account and the depository indicated
below:
Information
for Account
Please attach a void check to furnish encoding
details:
Contribution
Information
I (we) wish to contribute
$_______________ ($25.00 minimum) each month to The Land Trust of Huntsville
& North Alabama. I (we) understand that withdrawals/transfers will be
on the 15th day of each month.
I (we) agree that
neither The Land Trust of Huntsville & North Alabama nor First Commercial
Bank will be liable for any loss, liability, cost or expense for acting upon
such instructions. I (we) understand that I (we) will not receive a
transaction confirmation for each contribution from The Land Trust of
Huntsville & North Alabama. My (our) financial institution statement
will provide details for each transaction for my (our) records.
Authorization
Signature
_____________________________________________ Date___________________
Print Name
Here_______________________________________________________________
Telephone: Day
____________________________ Evening____________________________