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2. AUTHORIZATION AGREEMENT FOR DIRECT DEBIT

   I (we) hereby authorize CCMC hereinafter called Company, to initiate debit entries to my (our) Bank account indicated below at the depository named below, hereinafter called Depository, to debit the same to such account.  

4. Depository Name

   CCMC as agent of the Association
   8360 E Via de Ventura, Ste 100 Bldg L
   Scottsdale, Arizona 85258-3172
   (866) 244-2262

6. The authorization is to remain in full force and effect until COMPANY has received written notification from me (us) of its termination in such time and such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. 

8. I wish to:

   1. Establish a New Direct Debit Account
   2. Change the bank account my debits are currently drawn on
   3. Cancel my Direct Debit Account with PRCA
10. Association Name: Power Ranch Community
12. Association Account #: *
13. Start Date*
    Start Date
15. Association Account #:
16. Start Date:
    Start Date:
18. Name*
19. Email Address*
21. Address*
22. Phone Number
24. Account Type: *

    1. Checking
    2. Savings
25. Routing Number: *
26. Account Number:*
28. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature*
32. PRINT AND SUBMIT FOLLOWING BELOW INSTRUCTION

    Please attach a voided check (Not deposit ticket) & return this form to:

    CCMC 8360 E Via de Ventura
    Ste 100, Bldg L
    Scottsdale, Arizona 85258-3172

    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.

    FOREIGN BANK ACCOUNTS ARE NOT ELIGIBLE FOR THIS PROGRAM.

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33. Print Only

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