Pawling Self Storage
133 NY-22
Pawling, NY 12564
+18452882713

Automatic Payment Authorization Form

Pawling Self Storage, henceforth known as the Company, is now offering an automatic payment option.    With this option, your monthly payment will automatically be withdrawn from your checking account or your credit card account.

After filling out your personal information, please choose one billing option:
	Option 1)    Have your payment automatically withdrawn from your bank account
	Option 2)    Have your payment automatically charged to your credit card.

Personal Information
Name (as it appears on your account or credit card)    __________________________________________
Other names on your account or credit card        ________________________________________________

Current street address    ____________________________________________________
City, State Zip 	_________________________________________________________
Home phone	_________________________________________________________

Unit number(s) to be automatically paid _______________________________________

Billing options (select one)
	__                                            
	|__|    Charge my bank account    (a voided check must be attached to initiate this option)
	__                                            
	|__|    Charge my credit card

Required Information for Option 1: Charge my bank account
A voided check must be attached to initiate this option.

	Routing and transit number _______________________________                                                                        
	Checking/Savings account number _________________________ 

Routing and account numbers are located on checks as shown below
_____________________________________________________________________
|	Name							Check Number	|
|										|
| Pay To The Order Of ___________________________________	$____________	|
| Dollars _____________________________________________________________	|
|										|
|	00000000000000		11111111111111		2222222222		|
	00000000000000 = routing number
	11111111111111 = account number
	22222222222222 = check number

Required Information for Option 2: Charge my credit card
	
	Credit card type (like Visa) 	__________________________
	Card Number _______________________________________
	Expiration Date (mm/yy)    ______________
	Name on Card _____________________________________

	Credit Card Billing Address (where you receive your credit card statements)
	Street or P.O. Box ________________________________________________________
	City, State, Zip Code ______________________________________________________

I, ____________________, the undersigned, authorizie the management of Pawling Self Storage, to charge my checking account or credit card specified above for charges incurred on the unit numbers listed above on the __________ day of each month.     I also understand that the amount of the payments may vary each month.

I also understand that I may terminate this agreement by giving notice to the Company.    I may do this at any time in writing, but must allow a reasonable amount of time after receipt for the Company to act upon it.    I also understand that additional service charges may apply if payment is returned due to insufficient funds.

Please enroll my account(s) in the AutoPay Program selected by me.    

____________________________________________________
Tenant Signature				Date