Automatic Funds Transfer Approval - United Supply Company

Attention Accounts Receivable Department

I am giving approval to United Supply Company to transfer funds from the financial institution that I have previously designated in order to make payments on the following work orders and/or invoices. United Supply Company must have an original signed Automatic Fund Transfer Authorization Agreement on file to transfer funds.

Work Order(s)(Required)

Work Order

Amount

Invoice(s)(Required)

Invoice

Amount

Authorized Total Amount(Required)

Date(Required)

USC Account Number(Required)

Account Name(Required)

Authorized Person(Required)

First Last

Authorized Signature(Required)

Upon receipt of this approval funds will be processed immediately.

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