ACH Authorization Form

Credit/Debit authorization form to use Automated Clearing House network for the transfer of funds to SLS to cover costs per transaction.

Name(Required)

First Last

SLS Account Name(Required)

SLS Account Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Bank Account Information

Name of Financial Institution(Required)

Image of blank voided check

Max. file size: 512 MB.

Please add the file of the image of a voided blank check. This assures that we have the correct routing numbers. We will contact you if we have questions concerning this check. This is not a required option.

Date(Required)

Select One(Required)

Use ACH only when SLS is instructed

Use ACH every time an order is placed (you will receive an early pay 2% discount unless special pricing)

Use ACH on the 10th of each month for the previous month's orders.

You may pick one of these three options. SLS will follow this instruction unless re-directed. To re-direct your choices, please resend this form with your current choice.

ACH(Required)

Account Number Account Type Routing Number Account Holder Name

I (We) hereby authorize Southern Livestock Supply Co. Inc. to initiate entries to my (our) checking accounts at the Financial Institution listed below, and, if necessary initiate adjustments for any transactions credited / debited in error. This authority will remain in effect until Southern Livestock Supply Co. Inc. is notified by me (us) in writing to cancel It in such time as to afford Southern Livestock Supply Co. Inc. and The Financial Institution a reasonable opportunity to Act on it.

Signature - print(Required)

Your name printed

Signature(Required)