Ach Application

I (we) hereby authorize WENCAR, INC, hereinafter called the “COMPANY”, to initiate debit transactions to my (our) Checking AccountSavings Account (Select One) indicated below at the depository financial institution named below, hereafter called the “DEPOSITORY” and to debit such account as needed. I (we) understand that COMPANY will notify by me (us) by fax or e-mail prior to the debit providing the date and amount to be debited. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of the U.S. law.

Depository Name* Branch* City* State* Zip Code* Routing Number* Account Number*

This authorization is to remain in full force and effect until COMPANY has received written notification from me (us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Print Authorized Signature*
Authorized Signature*


Contact Information

Please notify the following prior to an ACH draft:

Contact Name* E-Mail* Fax*

Please draft the following store (s) on the day indicated below: (please list each Wencar account number)

  • Monday

  • Tuesday

  • Wednesday

  • Thursday

  • Friday