Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by International treaties. IT IS
ILLEGAL AND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER
PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United
States and Canada and by international treaties. IT IS ILLEGAL AND STRICTLY PROHIBITED TO
DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO
ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL
AUTOMATICALLY BE SUED IN A COURT OF LAW.
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the
United States & Canada and by international treaties. IT IS ILLEGAL AND STRICTLY PROHIBITED TO
DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO
ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE
SUED IN A COURT OF LAW.
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the
United States & Canada and by international treaties. IT IS ILLEGAL AND STRICTLY PROHIBITED TO
DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO
ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE
SUED IN A COURT OF LAW.

Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United
States and Canada and by international treaties. IT IS ILLEGAL AND STRICTLY PROHIBITED TO
DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO
ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL
AUTOMATICALLY BE SUED IN A COURT OF LAW.

February 27, 2014

Contact Name
Address
Address2
City, State/Province
Zip/Postal Code

OBJECT: PRE-AUTHORIZED PAYMENT, VARYING AMOUNT

Dear [CONTACT NAME],

This letter is to acknowledge that [COMPANY/INDIVIDUAL] is hereby authorized to withdraw the amount
due on our [NATURE OF CHARGES] on a [PERIOD OF PAYMENT] basis on the [NUMBER OF DAYS
AFTER BILLING DATE] day after the billing date:

Bank:
Bank Transit No:
Account No:

[BANK NAME AND ADDRESS]

[BANK TRANSIT NO.]
[ACCOUNT NUMBER]

Company Name
Street, City, State/Province, Zip/Postal code
Tel: (000) 000-0000 / Fax: (000) 000-0000
www.yourwebsite.com

 Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by International treaties. IT IS
ILLEGAL AND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER
PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

Bank Tel. No.

Bank Contact

[BANK TELEPHONE NUMBER]

[NAME OF BANK CONTACT & TITLE]

This shall be your good and sufficient authority for so doing. We enclose an unsigned check from the
account marked "VOID".

[NOTE: IF MORE THAN ONE SIGNATURE IS REQUIRED ON ACCOUNT, MAKE SURE BOTH BANK
SIGNING OFFICERS SIGN LETTER]

Sincerely,

Your name
Your title
(800) 123-4567
youremail@yourcompany.com

Company Name
Street, City, State/Province, Zip/Postal code
Tel: (000) 000-0000 / Fax: (000) 000-0000
www.yourwebsite.com