ePay with Checking or Savings
COHEAO ACH ePayment
Coalition of Higher Education Assistance Organizations
1101 Vermont Avenue, NW Suite 400
Washington, DC 20005-3586
www.coheao.org
Phone: 202-289-3910
Email: jwolfe@wpllc.net
COHEAO Newsletter 2005
Heartland ECSI
Raymond Leech
100 Global View Drive, Suite 800
Warrendale, PA 15086
Invoice for Commercial Primary Members
07/01/2005 -- 06/30/2006 Annual Dues
Payment Due: 06/01/2005
Please confirm the information that we have on file:

Email: rayathome@ecsi.net
Phone: 412-788-3900
Fax: 412-494-5626

2006 Membership Dues: Amount Due: 175.00

COHEAO continues to keep membership fees at last year's annual rates. Please review our records and make any necessary changes:

Items marked with () are required.

Member Information
Member's Name: (first last)
Organization:
Address:
City/State/Zip:
Phone:
FAX:
Email:

Banking Information
Payor (must be account holder) [Same as Above]
Name: (first last)
Address:
City/State/Zip:
Phone:
Email: (your confirmation is sent to this address)

Bank
ABA Transit Number: [Where to Find]
Account Number: [Where to Find]
Account Type: Checking Savings

Payment Information
Payment For: Annual Membership
Amount:
Please: No dollar signs or commas. Only digits and a single decimal point (e.g., 50.00)

Contract

You are about to request a payment be deducted electronically from your bank account. You must agree to the following.

  1. I authorize a debit entry to my account in the entity named above (financial institution).
  2. I authorize the financial institution to accept and to debit the amount of my entry to my account.
  3. Should this transaction fail for any reason (including invalid account numbers, closing my account before notifying ECSI to stop debiting, insufficient funds, etc.) I understand that additional penalties, fees and interest may accrue.
  4. By pressing the I Accept button below, I affirm that:
    1. I have read, understand and agree to be bound to the terms of this agreement
    2. I am authorized to perform this transaction by the legal party to the debt(s) shown above
    3. I am authorized to perform transactions to the financial institution's account shown above

I certify, under penalty of law, that the information provided is correct.

Return to the [Menu]
Return to the COHEAO Web Site without making a payment. If you leave now, none of the information above will be recorded on our web site.


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