MONTHLY AUTOMATIC DEDUCTION SIGN-UP (ACH)

NOW YOU CAN WRITE ONE LESS CHECK. Automatic deduction is a safe and convenient method of paying us the amount you owe. You just authorize us to notify your bank to transfer the amount you owe on the specified dates. It's that simple. The bank will continue to make your payments until you notify us you want it stopped. Paying your bill through Automatic Deduction means your money stays in your account until the day your payment is due. You never need to worry again about remembering to make your payment or lost payments due to unpredictable mail service. In addition to the convenience, you can save check and postage costs.

HOW DOES AUTOMATIC DEDUCTION WORK? You simply authorize us to notify your bank to transfer the amount of your bill to our bank account on the specified dates. We can work with almost any bank or financial institution in the area, and it will cost you nothing! If you change banks in the future, to ensure that your payments aren't interrupted or delayed, let us know the name of your new bank and account number well in advance of your next payment date. We will make all the necessary arrangements.

HOW WILL I KNOW THE CORRECT AMOUNT HAS BEEN TRANSFERRED EACH TIME? For your records, the transfer will appear on your bank statement. Should you ever feel that the transfer amount is incorrect, notify your bank to research the transfer. A reversal can be made up to 15 days after you receive your statement. Your bank can only transfer the amount that you have authorized to be transferred, and you can stop payment on a transfer just like checks drawn on your account.

CAN I CANCEL THIS AT ANYTIME? Certainly. Please refer to the tuition policy for details.

HOW DO I SIGN UP? It's easy. Complete the authorization form below, and we'll do the rest! If you have any other questions, please contact our Finance Manager, Debbie Gilbert, at the Synagogue office (847-869-4230 ext. 302) or via email.

Authorization Agreement for Automatic Deductions

I/We

hereby authorize Beth Emet The Free Synagogue to initiate debit entries to my checking account indicated below at the depository named below, ("Depository"), to debit the same to such account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.

Bank Name:

Routing Number (9 digit number)

Account No.

Total Amount To Be Deducted

Please note that if you wish to also include payments for other billing charges, please indicate below.

This authorization is to remain in force until Beth Emet The Free Synagogue has received written notification from me of its termination in such time and in such manner as to afford Beth Emet The Free Synagogue and Depository a reasonable opportunity to act on it. Please note that this form will need to be resubmitted for each year unless reconfirmed by you.

For the new membership year (beginning on July 1), do you wish to renew your deductions automatically?

I understand that payments will be deducted monthly on the 15th of each month - Deductions will be made in equal amounts from July 15 - June 15. Should you sign up after July 15, your monthly deduction amounts will be adjusted to ensure full payment by June 15. Please note that you will be assessed a $10 fee to cover Beth Emet's costs should a payment be denied for insufficient funds.

By including my/our initials below I/we understand that this is in lieu of my/our signature:

Initials:

Date:

Email Address:

Contact Information