[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-173840-en":3,"doc-seo-173840-105":28,"detail-sidebar-cat-1-en-105":90},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":11,"category_id":12,"category_name":13,"doc_title":14,"doc_description":15,"doc_content":16,"file_id":17,"file_url":18,"file_type":19,"file_size":20,"view_count":11,"is_deleted":4,"is_public":11,"is_downloadable":11,"audit_status":11,"page_count":11,"language":21,"language_code":22,"site_id":23,"html_lang":22,"table_of_contents":24,"faqs":25,"seo_title":26,"seo_description":15,"update_tm":27,"read_time":4},173840,2336475104362,"Mali","https://ap-avatar.wpscdn.com/avatar/22000c4c46a41b752dd?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786595829695023868",1,17,"Forms","Logic Authorization Agreement to Withdraw Funds (ACH Debits)","Logic underwriting/client authorization form for ACH debits, enabling a designated company to initiate debit entries to the client’s specified bank account. The form collects bank name, state, routing number, account number, and account holder details, and includes a payment deduction selection area. It defines the authorization’s duration until written termination notice is received, provides signature and date lines, and flags non-revocable written debit terms with limited exceptions for future recurring items.","Logic                AUTHORIZATION AGREEMENT TO WITHDRAW FUNDS         HMH\n(ACH DEBITS)\n(Check All that Apply)\n(  LOGIC UNDERWRITERS \t\tCLIENT NAME: _____________________\t\t  ( HMH PREMIUM FINANCE\t\tPOLICY/ACCT NO: __________________\n(  LOGIC INSURANCE SERVICES\tCLIENT NO: ________________________\nI (we) hereby authorize the checked company, to initiate a debit entry or entries to my/our account indicated below at the depository financial institution named below, hereinafter called THE BANK, and to debit the same to such account.\nBANK\nNAME_________________________________________________________________STATE_______________\nACCOUNT HOLDER(s) NAME____________________________________ PHONE NO.___________________\t\t\t\t                (Please Print)\nROUTING NUMBER   \t\t\t                    ACCOUNT NO.\nPAYMENT DEDUCTION: (Check One)\nThis 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 BANK a reasonable opportunity to act on it.\nAuthorized Signature: ________________________________________________ Date: __________________\n(Account Holders)\n________________________________________________ Date: _________________\nNOTE: ALL WRITTEN DEBIT AUTHORIZATIONS ARE NON-REVOKABLE WITH THE EXCEPTION OF FUTURE HMH REOCCURRING.\nALL PAYMENTS ARE A ONE TIME DRAFT AUTHORIZATION EXCEPT THE HMH REOCCURRING.\nPLACE VOIDED CHECK HERE.\nFAX FORM to 888-633-0607.\nATTENTION ACCOUNTING DEPT\nOR\nSCAN & EMAIL\nTO\naccounting@logicinsurance.com","cbCaidfsAaW57dvT","https://ap.wps.com/l/cbCaidfsAaW57dvT","doc",35840,"English","en",105,"# Authorization details\n## Bank and account information\n## Payment deduction and termination terms\n## Signatures and submission instructions","[{\"question\":\"What does this ACH authorization allow the company to do?\",\"answer\":\"It authorizes the checked company to initiate debit entry or entries to the client’s indicated bank account and debit the funds accordingly.\"},{\"question\":\"What information is required to complete the form?\",\"answer\":\"The form requests the bank name and state, account holder name(s), phone number, routing number, account number, and signature/date for the account holders.\"},{\"question\":\"How long does the authorization remain effective?\",\"answer\":\"The authorization remains in full force and effect until the company receives written notification of termination from the client in a time and manner that allows the company and bank a reasonable opportunity to act.\"}]","Logic Authorization Agreement to Withdraw Funds (ACH Debits) | 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