Please use this form to authorize Zeus Financial Services, LLC to debit your bank account for recurring payments as set forth in the Motor Vehicle Retail Installment Sales Contract.
Buyer Name Co-Buyer Name Loan Number
Bank Name Account Type CheckingSavings Name on the Account Routing Number Account Number Account Code PersonalBusiness Amount Frequency
Signature
By signing this document, I (we) voluntarily request and authorize Zeus Financial Services, LLC (hereinafter called Zeus Financial), to pay my auto loan by charging each payment to the bank account specified below. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of the U.S. law.
Printed Name Date
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