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Automated Clearinghouse (ACH) Customer Payment Program Authorization Form

 
I hereby authorize CoBank to automatically deposit payments for grain proceeds from Team Marketing Alliance LLC (TMA) to the account and financial institution identifed below. I acknowledge this authority will remain in effect until TMA receives written notice to cancel it.
 

Complete the form, click the print button, and return with a copy of a voided check to:

 
Team Marketing Alliance, Attn: Kali Jantz, P.O. Box 380, Moundridge, KS 67107
 

Customer Information

 
 
 
 
 
 
 
 

Financial Institution Information

 
 
 
 


 
 
 
 
 
 
By entering into this ACH authorization agreement, I hereby acknowledge that as a member of FCE of Halstead, CG&S, MKC or Central Prairie Co-op, payments for grain with the exception of defer pay or delayed pricing contracts constitute a per-unit retain allocation paid in money.