Application For
Direct Withdrawal of
Association Management Fees

Association Name


Your Name (First, Middle Initial, Last)
Your Contact Phone Number
Your Contact Email Address
Homeowner Account Number (As Listed On Your Coupons)
Name of Your Bank
ABA Number (Always the 9 digits preceding your account number on your check)
Your Account Number

Terms And Conditions:
I (we) hereby authorize First Choice Management(Company) to initiate debit entries to my (our) checking account at the depository, as indicated above. This authority is to remain in full force and effect until First Choice Management has received written notification from me (or either of us) of its termination in such time and in such manner as to afford First Choice Management and the Depository a reasonable opportunity to act on it. I (or either of us) have the right to stop payment of a debit entry by notification to Depository at such time as to afford Depository a reasonable opportunity to act on it prior to charging the account. After the account has been charged, I (we) have the right to have the amount of an erroneous debit immediately credited to my account by Depository, provided I (we) send written notice of such debit entry in error to Depository within 15 days following issuance of the account statement or 45 days after posting, whichever occurs first.
I have read the above statement and agree to its terms

 
 
   
   
 

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First Choice Management Group, Inc.
6485 N. Federal Highway 
Boca Raton, Florida 33487
Telephone: (561) 999-4349
Broward: (954) 449-8826
Dade: (786) 363-4420
West Palm Beach: (561) 340-3080
Toll Free: 1-866-547-7626
Fax: (561) 910-5797
       
   
First Choice Management Group is a member of the
Lippman Group of Companies