Please complete and sign this authorization form. Attach a voided check and return to Accounting Dept -
1083 California Avenue, Irvine, CA 92617. Your designated Financial Institution must be capable of
processing our automatic debit transaction. Please confirm this with your Financial Institution.
I (We) hereby authorize IRVINE CAMPUS HOUSING AUTHORITY, hereinafter called ICHA, to initiate
debits to my account indicated below at the Financial Institution named below in the amount of my monthly ICHA bill.
This authorization is to remain in full force until ICHA has received written notification from me (or either of us) of its termination in such a manner as to afford ICHA and the Financial Institution reasonable opportunity to act upon it.
Please continue to make your payments by check until you receive notification of the Direct Debit
start date from our Accounting Department.