Dear
Dealer ACH Authorization
Please help us ensure continued error-free processing of your funding advance(s) by providing the information requested below. Remember your original signature is required as authorization.
Please return the completed form via facsimile (801-312-0750) with original to follow by U.S. mail. Thank you.
DEALER NAME: _____________________________________________________________________________
DEALER ADDRESS: __________________________________________________________________________
BANK NAME ROUTING NUMBER ACCOUNT NUMBER
________________________________ _________________ __________________
AUTHORIZED SIGNERS
____________________________ ____________________________ _________________________
SIGNATURE NAME TITLE
____________________________ ____________________________ _________________________
SIGNATURE NAME TITLE
I, _______________________, __________________ of _________________________, on __________
NAME TITLE DEALER NAME DATE
Hereby authorize PAC Auto Finance to submit ACH credits (direct deposit) for our funding advances.
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