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Cardinal Management Group, A RealManage Company
703.569.5797

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Automatic Withdrawal Setup Form

Name *

Unit Address *

Community/Association Name *

Email *

Mailing Address (if different from above)

Financial Institution (Bank) Name *

Routing Number *

Confirm Routing Number *

Account Number *

Confirm Account Number *

Savings Account

If this is a savings account, please check this box.

Date *

This form must be submitted by the last business day of the month prior to the first automatic withdrawal *

By checking this box I, the owner of the unit address above, authorize Cardinal Management Group, LLC, on behalf of the Association to automatically debit the amount of my Association assessment from the account indicated above. This authority is to remain in full force and effect until the Association and the Financial Institution have received written notification from me of its termination in such time and manner as to afford the Association and the Financial Institution a reasonable opportunity to act upon the request. I further understand that payments will be deducted from my account between the first and tenth of each month in which the assessment is due, and should my payment be returned for any reason, I understand that I can be terminated from the program and I may be charged up to a $75.00 administrative fee. IMPORTANT NOTE: VERIFICATION OF ENROLLMENT OF DIRECT DEBIT WILL BE SENT VIA EMAIL.

Acknowledgement *

By checking this box, I acknowledge and understand that any unpaid balance on my account at the time of enrollment may be automatically withdrawn upon activation of this authorization.

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