About Us
Contact Us
Our Team
Buying From Us
History
Board of Directors
Locations
Corporate Office
Convenience Store
Renwick Fastway
Fort Dodge Ampride
Humboldt Ampride
Eagle Grove Ampride
Badger Fastway
Livermore Fastway
The Station
Cardtrols
Clare
Eagle Grove
Goldfield
Vincent
Woolstock
Services
Fuel
Delivery Area Map
Delivery Services
Contract Info
Tank Services
Propane
Delivery Area Map
Delivery Options
Contract Info
Tank Services
Furnace/Air Conditioner Repair
Products
Fuel
Varieties
Fuel Merchandise
Propane
About Propane
Propane Merchandise
Lubricants
Cenex
Syngard
Kerosene/Def
Furnace/Air Conditioners
Other Products
Forms
Employment
Customer Log In
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)
I (we) hereby authorize W & H Cooperative Oil Company, hereinafter call COMPANY, to initiate debit entries to my (our) Checking Account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of the U.S. law.
Bank Name
Branch
City
State
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
ZIP Code
Routing Number
Account Number
Type Of Account
Select one
Regular Account
Budget Account
Both
Payments are taken from your checking account on the 15th of each month. If the 15th of the month does not work for you, please enter a date below that will. Disclaimer: The payment will come out on the date of your choosing each month unless other arrangements have been made by the office. This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Payment date preferred if 15th does not work:
Customer First Name
Customer Last Name
W & H Customer Number
Signature
Date