I, the Customer named below, hereby authorize Ben Franklin Technology Partners of Southeastern Pennsylvania (“Ben Franklin” or the “Company”) to initiate a wire to my or savings account at the financial institution listed below (the “Financial Institution”).
This authorization will remain in effect until I notify Ben Franklin in writing (by mail to the attention of Cynthia Banaszak at Building 100 Innovation Center, 4801 South Broad Street, Suite 200, The Navy Yard, Philadelphia, Pennsylvania 19112; with a copy of such notice by contemporaneous email to cynthia@sep.benfranklin.org that I wish to revoke this authorization in such time as to afford Ben Franklin and the Financial Institution reasonable opportunity to act on my request. I understand that Ben Franklin requires at least ten (10) business days’ prior written notice in order to cancel this authorization.
Finanical Institution Information:
Customer Authorization: