Oxxford Hunt Agreement for Preauthorized Payments

Omega Association Management, Inc.
1010 Buck Jones Road
Raleigh, NC 27606
919-461-0102
919-461-0106 (fax)

AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS

I hereby authorize Omega Association Management, Inc., to initiate debit entries to my checking account indicated below and the financial institution below to debit the same to such account.

Date: __/__/____
Financial Institution: __________________________________________________
City/State/Zip Code: _________________________________________________
Account Number: __________________________________

I understand that this authorization will be in affect until I notify my financial institution and Omega Association Management, Inc. in writing that I no longer desire this service, allowing adequate time to act on my notification.

The amount and frequency of authorized debit is indicated below. I understand that as the association's assessment changes, the amount drafted from my account will change accordingly.

Association name: Oxxford Hunt Community Association
Assessment Amount: $35.00 monthly - to be drafted the 2nd Thursday of the month
Name: ________________________________________
Daytime Phone Number: ____________________
Social Security Number: ____________________
Property Address: _________________________________________
Alternate Mailing Address (if applicable): ___________________________________
City/State/Zip Code: ______________________________________

Signature ______________________________

*For this application to be processed:

  • It must be completed in its entirety.
  • A voided check must be attached (deposit slips are not acceptable).
  • Incomplete applications will be returned by mail to the homeowner.

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    TO BE COMPLETED BY OMEGA:
    Routing/Transit #:  
    Bank Account #:  
    Cancellation Date: