Sign up for Automatic Payments. Do you want your United Quality Cooperative account balance paid each & every month automatically?Fill out the form below and Kelsey or Kali will be in touch with you! Name(s) on United Quality Cooperative Account * United Quality Cooperative Account Number * Billing Address, City, State, Zip Code * Email * Phone * (###) ### #### Name(s) on Bank Account * Bank Routing Number * Bank Account Number * Bank Name, City, State * Bank Account Type * Checking Savings Please check the boxes below * Email image of voided check to kelseyd@uqcoop.com I authorize United Quality Cooperative to debit the bank account indicated above on the scheduled due date (25th) of each month for payment of my account statement balance. I agree with the terms below I understand and agree that any and all changes in my account information, including requests to terminate this agreement, must be in writing and be delivered to United Quality Cooperative (UQC), at least 21 days prior to the next due date. If the payment due date falls on a weekend or holiday, I understand and agree that the payment may be executed on the next business day. I understand and agree that as this is an electronic transaction, adequate funds must be available for withdrawal from my account by the payment due date. In the case of an ACH transaction being rejected for Non-Sufficient Funds (NSF), submission error, or other bank related return reasons I understand and agree that UQC may at its discretion resubmit the ACH debit transaction within ten (10) days. I understand and agree that, in accordance with the credit policy, a late charge will be assessed if the amount due is not received in good and collected funds by the end of the grace period. I also understand and agree that a return item charge may be assessed for each returned ACH debit. I acknowledge that the origination of ACH transactions to my account must comply with provisions of U.S. law and agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form. Electronic Signature * Please type in your full name in lieu of a signature Today's date * MM DD YYYY Thank you!
