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Direct Automatic Payment Authorization Form
The Wisconsin Dental Association is pleased to offer the monthly installment plan for paying your dues. By selecting the option to
pay in monthly ACH Installments
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How to fill out direct automatic payment authorization

How to fill out direct automatic payment authorization:
01
Obtain the direct automatic payment authorization form from your bank or financial institution. This form may also be available online on their website.
02
Fill in your personal information accurately, including your full name, contact information, and account details. This will ensure that the authorization is linked to the correct account.
03
Specify the payment amount or range. Indicate whether you would like a fixed amount to be deducted or if you prefer to authorize a payment within a certain range.
04
Choose the frequency of the automatic payments. You may have the option to select monthly, bi-weekly, or another frequency that aligns with your payment schedule.
05
Provide the start date for the automatic payments. This is the date from which the payments will begin to be deducted from your account.
06
If applicable, indicate the end date for the automatic payments. This is the date from which the payments will stop being deducted. If there is no specified end date, leave this section blank.
07
Read the terms and conditions carefully. Ensure that you understand the agreement and the responsibilities associated with authorizing direct automatic payments.
08
Review the information you have provided on the form. Ensure that there are no errors or omissions before signing and submitting the authorization form.
09
Sign the form as required. Some authorization forms may require both your signature and the signature of a witness or representative from the bank or financial institution.
10
Submit the completed form to your bank or financial institution. You may need to submit it in person, through mail, or electronically, depending on their specific requirements.
Who needs direct automatic payment authorization?
Direct automatic payment authorization can be beneficial for individuals or businesses who have recurring payments or bills. This can include:
01
Individuals who have monthly rent or mortgage payments.
02
Businesses that have regular monthly expenses, such as utilities or subscription services.
03
Individuals who want to automate their savings or investment contributions.
04
Businesses or individuals who have loan or credit card payments.
05
Those who want to ensure timely bill payments, avoid late fees, or simplify their financial management.
It is important to note that the need for direct automatic payment authorization will vary depending on individual circumstances and financial obligations. It is advisable to consult with your bank or financial institution to determine if this payment method is suitable for your specific needs.
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What is direct automatic payment authorization?
Direct automatic payment authorization is a process where a payer authorizes a financial institution to automatically deduct funds from their account to pay bills or make payments.
Who is required to file direct automatic payment authorization?
Individuals or businesses who wish to set up automatic payments for bills or services are required to file direct automatic payment authorization.
How to fill out direct automatic payment authorization?
To fill out direct automatic payment authorization, one must provide their banking information, the amount to be deducted, the frequency of deductions, and the payee details.
What is the purpose of direct automatic payment authorization?
The purpose of direct automatic payment authorization is to simplify bill payment processes and ensure timely payments without the need for manual intervention.
What information must be reported on direct automatic payment authorization?
Information such as the payer's bank account details, the amount to be deducted, the frequency of deductions, and the payee's details must be reported on direct automatic payment authorization.
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