Instructions: Complete the form below and attach an unsigned and voided check from this account to assist in verifying data.
I (we) authorize Village of Westchester hereafter called "Company", to initiate debit entries to my (our) checking account indicated
below and the financial institution named below, hereinafter called "Institution", to debit the same such account.
I (we) further authorize "Company" to initiate credits to my (our) account to correct any errors, and "Institution" to initiate any such
corrections to my (our) account. This authority is to remain in full force and effect until "Company" and "Institution" has received
written notification from me (or either of us) of its termination in such time and in such manner as to afford "Company" and
"Institution" a reasonable opportunity to act on it prior to depositing to the account.