Bank Account Debit Authorization Agreement

Please complete this form in order to complete the setup of your Green Marimba service(s), and to confirm your authorization to bill for the the service(s).
I hereby authorize Green Marimba Technologies LLC to debit our bank account for all fees incurred on my Green Marimba account. I have read and understood the Terms of Use Agreement and by signing below, am agreeing to the terms set forth there.
  • Name of the account as it appears on the bank statement.
  • Address of the account as it appears on the bank statement.
  • City of the account as it appears on the bank statement.
  • State of the account as it appears on the bank statement.
  • Zip code of the account as it appears on the bank statement.
  • 9-digit ABA routing number.
  • Your title in the organization.
  • To e-sign this authorization, type your name in this format: /first-name last-name/
Cannabis Software by Green Marimba
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