COMPANY CONTACT PERSON INFORMATION
INFORMATION FOR AUTOMATIC CLEARING HOUSE TRANSACTIONS
(ACH DEBITS AND CREDITS
Fund My Contract's program is funded and serviced by United Midwest Savings Bank - member FDIC.
By signing below, I (we) hereby authorize United Midwest Savings Bank ("UMWSB") to initiate debit and credit entries to the depository account specified above.
The authority is to remain in full force and effect until UMWSB has received written notification from merchant of its termination in such time and in such manner as
to afford UMWSB and DEPOSITORY a reasonable opportunity to act upon it.
The Dealer and the authorized person signing below on behalf of the business entity "Dealer" submit the above information as being true and accurate as of the
date shown. The Dealer further agrees that UMWSB may at its discretion make whatever inquiries it deems necessary, in connection with the information contained
herein or in the course of the review or collection of any credit extended in reliance on this information. The Dealer authorizes any person or Consumer Reporting
Agency to compile and furnish UMWSB any information it may have in response to such credit inquiries.
The Dealer agrees to immediately notify UMWSB of any change in ownership. UMWSB promises not to divulge any information contained herein to any individual,
company or entity for any reason. This information is for internal use only to establish financial soundness and creditworthiness of the Dealer. The dealer gives
express permission to UMWSB to use Constant Contact to send promotional emails at UMWSB’s discretion. The dealer may opt out of these emails at any time by
using the "safe unsubscribe" feature provided by Constant Contact.