Authorization for Autopay :: United Quality Cooperative

United Quality Cooperative Account Number Required

Billing Address, City, State, Zip Required

Email Address Required

Phone Number Required

Account Type Required

Name(s) on Bank Account Required

Bank Name, City, State Required

Bank Routing Number Required

Bank Account Number Required

Date Required

By checking the box below, I authorize United Quality Cooperative to debit the bank account indicated above on the scheduled due date (20th) of each month for payment of my account statement balance. Required

Please type in your full name in lieu of a signature Required

***Please email image of voided check to kalim@uqcoop.com***

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.

Authorization for Autopay

Do you want your United Quality Cooperative account balance paid each & every month automatically? Fill out the form below and a member service representative will be in touch with you!

Do you want your United Quality Cooperative account balance paid each & every month automatically?

Fill out the form below and a member service representative will be in touch with you!