Below is the  Pre-Authorized Payment Specific Amounttemplate body. If necessary, please put the personal information, company information, such as text to replace the specific content you need. you can download the .doc template file on the end of the article by click download link. 



March 11, 2014


Contact Name
Address
Address2  
City, State/Province
Zip/Postal Code



OBJECT: PRE-AUTHORIZED PAYMENT, SPECIFIC AMOUNT


Dear [CONTACT NAME],

This letter is to acknowledge that [COMPANY/INDIVIDUAL] is hereby authorized to withdraw the amount of [AMOUNT OF PERIODIC DEBIT] on a [PERIOD OF PAYMENT] basis on the [BILLING DATE] of each month, until we decide to cancel your services in respect to the terms and conditions we both agreed on. Please withdraw the funds from the following bank account:


Bank:      [BANK NAME AND ADDRESS]
Bank Transit No:  [BANK TRANSIT NO]
Account No:    [ACCOUNT NUMBER]
Bank Tel. No.    [BANK TELEPHONE NO]
Bank Contact    [NAME OF BANK CONTACT & TITLE]


This shall be your good and sufficient authority for doing so. We enclose a blank check from the account marked "VOID".


[NOTE: IF MORE THAN ONE SIGNATURE IS REQUIRED FOR THIS ACCOUNT, MAKE SURE BOTH BANK SIGNING OFFICERS SIGN LETTER]


Sincerely,




[YOUR NAME]
[YOUR TITLE]
[YOUR PHONE NUMBER]
[YOUREMAIL@YOURCOMPANY.COM] 


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