Dobson Ranch Homeowners Association 2719 S. Reyes ♦ Mesa, AZ 85202 ♦ 480-831-8314
PRE-AUTHORIZED ELECTRONIC ASSESSMENT PAYMENT AGREEMENT
NAME____________________________________________________________________________ (LAST, FIRST, MI) ADDRESS OF DOBSON RANCH PROPERTY____________________________________ TELEPHONE-HOME_______________________ CELL/WORK______________________ DOBSON RANCH ACCT. NUMBER___________________________ effective date_______________ PLEASE COMPLETE BANK INFORMATION BELOW AND ATTACH A VOIDED CHECK. BANK NAME__________________________________ ROUTING NUMBER_________________BANK ACCOUNT NUMBER___________________
Please note: The order of the routing number, check number and account number will not always be in the same position. If you can identify the check number and your checking account number, the 9 digit number remaining is the bank routing number.
I hereby authorize The Dobson Association, Inc. to initiate debit entries from my account at the bank named above. I understand the debit will be done on the 5th of each month with the money being withdrawn 1-2 days afterwards. This authority is to remain in full force and effect until The Dobson Association, Inc. has received written notification from me of its termination in a manner as to afford a reasonable opportunity to act upon it. Notice of any future rate change to your HOA assessment will be published in the Oct. or Nov. issue of the Ranchers’ Round Up, no coupons will be issued. Please note that in the event of a rate change, the Dobson Association will adjust the debited amount accordingly. _____________________________________ Signature
__________________________ Date