Sign and complete this form to authorize Spring Lake Property Association, Inc., to make a one (1) time debit/credit/e-check to your credit/debit/e-check account.
*By signing this form, you give SLPA permission to debit your bank account for the amount
indicated -Please add a convenience fee of $2.50 to your total amount paid- This permission
is for a single transaction only.
I, ___________________________ authorize SLPA to charge my bank account as indicated
Name as it appears on Statement:
Add the convenience fee of $2.50 to total payment.
