Kramer-Triad (Troy Office) Authorization Form for Consumer Withdrawal

(Monthly Withdrawals)

Please use this form to have your monthly Association Fees withdrawn directly from your account.  Please check the box below to indicate your preference for withdrawal from a checking or savings account. This form must be received by the last day of the month in order for the following month’s payment to be withdrawn. All direct payments will be withdrawn from your account on the 6th of each month.

Community Name     ____Manors at Central Park_______________________                                                                           

Name                                                                                                                                     

Address                                                                                                                                 

City/State                                                                                                                              

Account # on coupon                                               Daytime Phone #           (           )                      

                I authorize Kramer-Triad Management Group to instruct my bank to make my regular monthly Association payments.  Additional Assessments, maintenance bill-backs, and any other charges on my account will require my additional authorization for payments of these charges.  I also understand I may discontinue this authorization at any time by giving written notice to Kramer-Triad Management Group.  I realize that this information will be used solely for the purpose of making payments to my Condominium/Cooperative.

Bank or Institution Name              _______________________________________

            Bank Routing Number                _______________________________________

       Bank savings account #                                                                                              

       Bank checking account #                                                                             

Note: Please attach a voided check and payment coupon to this form.

Withdrawals will be done on a monthly basis.

Effective Date   ___________________________________________

Signature                                                                       Date __________________

For your convenience you may mail to the address below, fax this form back to 248-879-5507 or you may scan the completed form and voided check and at the Kramer-Triad office in Troy.