provide a letter on bank letterhead stating your name, account number, routing number, and that this is a savings account. Please note: If you do not provide ALL of the requirements ...
Direct Deposit Instructions and Information (Optional): You have the option to sign-up for Direct Deposit where your payments will be directly deposited into your checking or savings account instead of receiving a physical check every month. Direct Deposit allows you faster and timely access to your payments. This option is no cost to you; however, your bank may have fees associated with Direct Deposit transactions. Physical checks are mailed out via USPS mail and delivery times may vary, therefore, it is in your best interest to sign-up for this option. To sign-up for Direct Deposit: 1. You must have an e-mail address where Antero Resources will e-mail your statement detail 2. Fill out the Electronic Funds Transfer Authorization Agreement form 3. For a checking account: enclose a void check this is required for account verification purposes (Name on check must match the payee/owner name or company name we have on file for the account) 4. For a savings account: provide a letter on bank letterhead stating your name, account number, routing number, and that this is a savings account Please note: If you do not provide ALL of the requirements above you will not be opted into Direct Deposit and will receive physical checks. You may receive this form multiple times, however, only one is needed to be filled out and returned to Antero Resources. The Electronic Funds Transfer Authorization Agreement will cover all properties associated with this payee/owner number. Sincerely, Accounting Department Email: directdeposit@anteroresources.com Inquiry Line: (303) 357-6405 *Press 1 for Direct Deposit Inquiries Website: http://www.anteroresources.com/owner-relations *PLEASE DISREGARD IF YOU HAVE PREVIOUSLY SUBMITTED A DIRECT DEPOSIT FORM* Electronic Funds Transfer Authorization Agreement ACH (Direct Deposit) Payments Payee Information Payee/Owner number Name on Account Legal Name of Business Address City, State and Zip Federal Tax ID No./SSN _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ Bank Information: (ACH Banking Info.) Bank Name _______________________________________ Address _______________________________________ City, State and Zip _______________________________________ Bank Routing No. (ABA) _______________________________________ Bank Account Number _______________________________________ Required: Payee's Remittance E-Mail Address _______________________________________ (Must have to send you statements) Required: Enclose void check for account verification purposes The undersigned hereby authorizes Antero Resources Corporation to make electronic funds transfers to the bank account specified above for the named Vendor for payment for goods and/or services. I hereby certify that I am duly authorized to sign this Authorization Agreement on behalf of said Vendor and that Antero may rely on this authorization and any instructions of the undersigned or any one of the above named Vendor Contacts in connection with funds transfers. I agree to provide Antero with a new Authorization Agreement, duly completed and executed, in the event of any changes, including changes in contact information. Antero shall be entitled to rely on the most recently dated Authorization Agreement which will supersede all previous agreements. Payee Authorization Name __________________________ Signature _______________________________ Title __________________________ Date ___________________________________ (if account other than individual, include title, e.g. "Trustee" or "President") PLEASE DISREGARD IF YOU HAVE PREVIOUSLY SUBMITTED A DIRECT DEPOSIT FORMEmily Tucker Adobe PDF Library 15.0