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ACH AUTHORIZATION FORM I, the undersigned hereby agree that HighMark Energy Operating, LLC may reverse any electronic payment that is determined to be duplicate or made in error. I further agree that authorization of EFT (electronic funds transfer) as evidenced by the signature below amends my existing payment instructions and such authorization will remain in effect until otherwise cancelled by way of written notification to HighMark Energy Operating, LLC. I also acknowledge that I may change any portion of the information provided below by giving at least thirty (30) days written notice. The 30 day notice begins at such time the notice is received and date stamped by HighMark Energy Operating, LLC. I agree that HighMark Energy Operating, LLC will not be liable for any interest or other claim arising as a result of Owner’s failure to give such notice. I hereby agree to the terms stipulated herein, certify that the depository information listed below is accurate and authorize HighMark Energy Operating, LLC to issue payments to me electronically via EFT. Please allow up to two revenue check cycles for this process to be completed. Owner Number: ___________ Account Name: ______ _______________________ Address: _________________________________ City, State, ZIP _________________________________ Last 4 digits of Tax ID or Social Security Number: ___________ Account Type: __________Checking _________Savings Name of Bank: ______________________________________ Bank Account Number: ________________________________ Routing Number: ____________________________________ _____ New Request _____ Change Existing Set-Up Signature: ___________________________________ Print Name: __________________________________ Title: ________________________________________ (E.G., “Owner”, “Trustee” or “Officer of Company”) Daytime Phone Number: ________________________ E-mail: ______________________________________ Date: _______________ Please check the box below to indicate that you acknowledge that in signing up for EFT/ACH you accept that your check revenue detail will only be available electronically at www.energylink.com. Should you not check the box below, the EFT/ACH form will not be processed and you will continue to receive a check. I hereby acknowledge that my revenue detail will only be available electronically via www.energylink.com. . Return the form, along with a voided check (no deposit slip accepted), via mail to HighMark Energy Operating, LLC, Attn: Accounting, 909 Lake Carolyn Pkwy, Suite 1500, Irving, TX 75039 or fax to 972-556-2953, attention to Accounting / Direct Deposit. If you need additional information related to Direct Deposit (ETF) payments, please call 972-556-2950 or email us at [email protected] .