The Crescent-News EZ PAY Debit Banking Form I am choosing to have my monthly subscription payment to The Crescent-News automatically deducted from my bank account each month with EZ Pay. The same amount is withdrawn each month within two business days of processing the request on either the 5th or 20th of the month. Please enclose a voided check, complete and sign the form below and return to The Crescent-News, PO Box 249, Defiance, OH 43512. Please deduct from my Checking $
Savings $
Bank / Credit Union Routing # Account # Signature Date
Debit Date:
5th OR 20th
(circle one please)
Terms and conditions: By signing you agree that you are the authorized person on the account listed above. You authorize your financial institution to debit the account for the amount of the EZ Pay option and make a payment to The Crescent-News. The monthly debit will appear on your bank statement for the date (or within two business days) thereafter circled above. You understand that you will be provided with at least 12 days notice if the amount is different. You have the right to stop payment of a charge by notifying The Crescent- News up to 3 business days prior to the date selected to debit your account. This authority will remain in effect until revoked by you, the financial institution, or The Crescent-News. You agree to notify The Crescent-News of any address, financial institution or account changes. Fraudulent information may be forwarded to legal authorities.