Automatic Payment Authorization

If you have recently switched financial institutions to TASI® Bank, Division of Bank of Guam, fill in this form to redirect your automatic payments from your old account and begin collecting or charging from your new TASI Bank account.

Effective Date

Enter the date on which you would like us to start redirecting your automatic payments from your old account and begin collecting or charging from your new TASI Bank account as indicated below

Year

Month

Day

New Account Information:

(Enter your TASI Bank information here)

TASI Bank ACH Routing Number

Account Number

Account Type

Checking

Savings

Enter the company you want payments directed to here:

Name

Address

Street

City

ZIP / Postal Code

State / Province

From: (Enter your business information here)

Customer Name

Account Number

Customer Address

Street

City

ZIP / Postal Code

State / Province

Phone Number

Electronic signature

Typing your full name below signifies that you are completing this form using an electronic signature. By signing electronically, you are certifying that you have read and understood the consent message and agree to electronically sign.
To continue with the electronic signature process, please enter your full name and submit the form.

Signature

Date

Confirmation

By checking this box, you are allowing TASI® Bank to redirect your automatic payments from your old payment account to your new TASI Bank account. After submitting this form, we will begin collecting and charging your new account, indicated above.