(914) 654-1414

2975 Westchester Ave. Ste G1 Purchase, NY 10577

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ACH Debit Form

Authorization for Direct Debit

I authorize Gramatan Management to debit my bank account listed below each fifth(5th) business day of the month for payment of maintenance charges and all other billing charges including assessments, repairs charges, and etc..

I understand that a $50.00 processing fee will be assessed should funds not be available in the designated bank account on the 5th business day of any months in any annual period. 

A new authorizition form will be required for any change of bank account or financial institution. 

This authorization will remain in effect until written cancellation notice is recieved. Any changes must be recieved by the 15th of the month for next month's billing. 

Name *
E-mail *
Property Address *
Phone Number *
Bank Name *
Bank Routing Number *
Bank Account Number *
Authorized Signature *
Please type out full name.
Month Direct Debit Will Begin *
Please keep in mind that direct debit must be sent in prior to the 25th of the prior month.
Upload Voided Check for Processing *

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(914) 654 - 1414 Send us an email

Gramatan Management
2975 Westchester Ave., Ste. G01, Purchase, NY 10577