Laserfiche WebLink
a' <br />ACH Debit Blocking Service Setup Form 3.5_03_29_'10 <br />Note: P /ease type a// information <br />Signature of Authorized Signer is Required in Section B <br />Section B: <br />7. Add additional Allowable Co ID to existing account on Debit Block: (Modifications on /y) OR <br />Increase dollar amount for an existing Allowable Co ID: lMod� cations on /v) <br />Select One <br />I Select Bank Number I <br />Select Bank Number <br />Select Bank Number <br />Select Bank Number <br />Select Bank Number <br />Select Bank Number <br />Select Bank Number <br />Select Bank Number <br />Select Bank Number <br />Select Bank Number <br />Allowable Company Max Dollar Amt <br />IDs of a Single ACH <br />DPtllt <br />as allowable to revent settlements from re ectin <br />920040706'1 � <br />If Co ID is less <br />than 10 digits, <br />space is <br />_ _ � _ <br />_ _ � _ <br />- - • - <br />- - • - <br />Maximum Debit Dollar Amount <br />�m nanv Ir <br />Select Bank•Number <br />Select Bank Number <br />Select Bank Number <br />__ –_– __ _ .................._._ - <br />Select Bank Number <br />This form should be delivered to JPMorgan Chase Bank, N.A., o/o JPMorgan Treasury Services [Address], <br />Print Name of Customer- CITY OF SANTA ANA <br />Authorized Signature <br />PrintName 8 Title of Signer NO SIGNATURE REQUIRED <br />Authorized Signature <br />Print Name � Title of Signer '. NO SIGNATURE REQUIRED <br />Date NO SIGNATURE REQUIRED <br />' F �. � ��I'. k° L. d.;. 1 .��'��*,�°'2°""vf9'T',,.";�.,Ft �.;�,. �vx,. �f �h� �� 5 °�1 �����`1 �t:e �`a.x��?, >�":sar` "- sas..,�.�i.xci�' y L1.1 .�,a��lv:!. «�. w,v. <br />..�J' �...x .mss. .,. a ....�.4.:m�_.�k..'�_^`,11'�A.�Q <br />. • — � • — . <br />PN: 363374 DOC ID: 4C /TY OF SANTA ANA -Nov. fs, 2ofOPage 8 of 25 <br />