Bank Account Debit Authorization-Single Occurrence
"This document authorizes a company to automatically deduct money from an account of a third party as set forth in the form for a one time occurrence only. The form can be used by companies utilizing automatic debit for payment or for an individual desiring to permit a company to make one debit from the account. It can be revised to permit an individual to deduct money from an account rather than a company. This document can be used by parties who wish to allow another party to deduct money from their account for one time only.
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