Please Fax this to (617) 701-1750 or scan it as a PDF FILE ONLY to email@example.com
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To: Alanita Travel®, 87 Common Street, Watertown, MA 02472
Ph: (617)923-4810 Fax No:(617) 701-1750
ONE TIME ACH PAYMENT AUTHORIZATION FORM
By signing this form you gave us permission to debit your account for the amount indicated on or after the indicated date.
This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your
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