Print this page, complete and mail to:

WAM Computers
211 N. State, PO Box 261
Litchfield, IL 62056

WAM Computers

Bank Debit Authorization Form


Name: ______________________________________

Internet Account Number or login name: ________________

Account Type (Circle one)    Checking     Savings

For Checking account, Please attach a voided check.

Complete this section for savings account only:
Name of Financial Institution:
Address of financial Institution -
Branch, Street, City, State & Zip
Bank Account Number:
Financial Institution's Routing Number:

I hereby authorize WAM Computers to initiate debit entries to my bank account as indicated above and to credit WAM Computers the amount of $14.95 monthly for Internet access.

This authorization is to remain in full force and effect until WAM Computers has received written notification from me of its termination in such time and in such manner as to afford WAM Computers a reasonable opportunity to act upon it. My Internet service will continue to the end of the month that WAM Computers received notification. If I do not have sufficient funds in my account to pay the amount listed, I understand that my bank may charge an NSF service charge.


Signed: _____________________________________ Date: _______________