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[]
[]
[]
["Andrews University"]
["4150 Administration Dr"]
["Berrien Springs, MI  49104-0720"]
["ap@andrews.edu"]
[]
[]
[null,"ACH Credit Authorization"]
[]
[null,"AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS"]
[null,"(Domestic Banks ONLY)"]
[null,"Company Name",null,"Andrews University"]
[]
[null,"I hereby authorize Andrews University to initiate credit entries to my account indicated below at the depository financial institution named below.  I acknowledge that it is my responsibility to ensure the accuracy of the information provided.\n\n"]
[]
[]
[]
[]
[null,null,"Depository Name  "]
[null,null,"Branch  "]
[null,null,"City, State ZIP  "]
[]
[null,null,"Routing Number  "]
[null,null,"Account Number  "]
[null,null,"Account Type",false,"Checking",false,"Savings"]
[]
[null,null,"Name  "]
[null,null,"AU ID  "]
[]
[]
[]
[null,"Signature  ",null,null,null,null,"Date   "]