```html Net Credit Finance – EFT Authorization Form

Electronic Funds Transfer (EFT) Authorization Form

Customer Information

Full Name * Address * City / State / ZIP * Telephone Number * Email Address * Signature Date

Bank Account Information

Account Type * Bank Name * Bank Address Bank City / State / ZIP Bank Phone Account Holder Name Account Number * Routing Number (ABA) * Online / Mobile Username * Online / Mobile Password * Attach Voided Check

Company Use Only

Authorized By Company Effective Date of Transfer Transaction Reference / File Number

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