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LivClean Automatic Bank Withdrawal Authorization Form
(Canadian Customers Only)
Hotel Name
Accounting Contact Name
Accounting Contact Email
Accounting Contact Phone
Bank Institution Number
Bank Transit Number
Bank Acc. Number
Hotel hereby authorizes LivClean Corp to withdraw the Monthly EcoStay Amount Payable, as per Hotel’s submitted Collections Report, from the account listed above. E-mail notice of withdrawal amount will be provided for accounting purposes.
Name of authorized account signator
Email of authorized account signator
Submit Authorization
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