Terms of Use:  By submitting this form, I agree to allow Green Marimba Technologies LLC to debit my bank account for pre-approved and recurring invoices.

Bank Authorization Form

  • 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.
  • Email addresses to receive billing notifications.
  • To e-sign this authorization, type your name in this format: /first-name last-name/