USE THIS FORM TO PAY YOUR FEES AUTOMATICALLY
THE CO-OP DOES NOT CHARGE ANYTHING FOR THIS SERVICE
AUTHORIZATION AGREEMENT FOR PREAUTHORIZED DEBITS
SHAREHOLDER NAME(S) _______________________________________ ("Owner")
APARTMENT NUMBER ___
1. The Owner
(A) authorizes Tudor Realty Services Corp. ("Debiting Party")as Agent for 350 Bleecker
Street Apartment Corp. (the "Building") to initiate Automated Clearing House (ACH)
debit entries from the Owner at the Owner's depository ("Depository") identified in
Section 2, below, for deposit into the Building's account at Citibank, in amounts as
provided in the monthly billing of charges sent to the Owner from the Debiting Party,
as Agent for the Building, and
(B) authorizes the Depository to debit said entries to the account identified in section 2 below.
2. Depository (Bank) Name (THE NAME AS LISTED ON OWNER'S CHECKING ACCOUNT)
_________________________________
The account number and account name(s) are as shown on the void check that is attached to
this form. (Please write VOID across the front of a blank check. Do not sign the check.)
3. This authorization is to remain in full force and effect until the Debiting Party or the
Depository have received written notification of its termination of same in such time and in
such manner as to afford the Debiting Party and the Depository a reasonable opportunity to act on it.
Owner:___________________________ Telephone No.: ________________________
Date:______________________
ATTACH COPY OF CHECK MARKED "VOID" TO THIS FORM.
FAX FORM AND VOIDED CHECK TO TUDOR MANAGEMENT, 212-557-9329