To make a payment by ACH (electronic debit from your bank account), click here to print this form.
All payments should be directed to:
ACH PAYMENTS
Litow & Pech, P.C.
PO Box 2143
Cedar Rapids, IA 52406
To ensure accurate and prompt posting of payments, use this ACH form or request payment coupons by email or phone.
AUTHORIZATION TO HONOR FUNDS TRANSFERS DIRECTED BY LITOW & PECH, P.C.
You are hereby authorized as a convenience to me, to pay and charge to my above account any transfer of funds, (whether by automatic debit entry, the drawing of a check or any other means permitted by law, directed by and payable to the order of LITOW & PECH, P.C. for payment on account, provided there are sufficient collected funds in such account to pay same on scheduled transfer date. I agree that your rights in respect to each such transfer shall be the same as if it were a check or other item drawn on you and signed personally by me. The authority is to remain in effect until revoked by me in writing and until you actually receive such notice and have reasonable opportunity to act on it. I agree you shall be fully protected in making any such transfer of funds.
Authorized Signature:____________________________________________ Date:____________
Printed Name of Depositor:________________________________________
NOTE TO DEPOSITOR: A VOIDED CHECK MUST ACCOMPANY THIS FORM
Payment Amount:________________
Frequency of payment (check one):
___weekly ___monthly ___one-time payment ___other
Start Date: _______________
The initial payment will be applied on either the start date or the date the form is received in our office, whichever is later.
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