Customer Name *:

Customer Email *:

AC Credit Loan Number * (5 digits):

Bank Name *:

Routing Number * (9 digits):

Bank Account Number *:

Account Type *:

CheckingSavings

Payment Amount *:

Payment Posting Date *:

Payment Schedule *:

One-Time WithdrawalMonthly Recurring Withdrawal on same date each month

REVIEW & SUBMIT

By Clicking Submit:

I (We) hereby authorize AC Credit, Inc., here after called COMPANY, to initiate debit entries to my (our) Checking/Savings account indicated above at the depository, hereafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to (our) account must comply with the provisions of U.S. law.

This authorization is to remain in full force and effect until COMPANY has received notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY AND DEPOISTORY a reasonable opportunity to act on it.

Note: All written debit authorizations must provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.

I Agree