Old Father Time
PO Box 1265
Kill Devil Hills, NC 27948
 
 
E-Check Authorization Form
 



Name
(as it appears on your bank statement)
Address 
(as it appears on your bank statement)
Add'l. Address

City
  State   Zip + 4

Bank Routing Number 
(9 Digit Bank Identifying Number)
Bank Name 

Phone Number
(Your bank may call you to verify)
Bank Account Number 
(Your checking account number)
Amount to be Drafted
  in payment for OFT Order #

Type of Account (check one)

  Consumer Checking
  Consumer Savings
  Business Checking
  Business Savings

I, the undersigned, agree to allow OLD FATHER TIME to electronically debit my bank account or create and
process a demand draft against my bank account in the amount shown above, on or after today's date. I am
providing a copy of this transaction to Old Father Time by mail or email.  Old Father Time may (if requested),
provide it to the card processing bank.


     
Signature                                                                                                                  Date

(This data on this form is not sent through the internet, it is only indended for PRINT.)
Please Complete this Form on your screen, then print it and send by fax 1-(888) 668-1150, postal mail, or email
attachment to
watchmakers@oldfathertime.com