Direct Debit Information
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NPAM Direct Debit Information

With Direct Debit, your NPAM dues are paid in increments throughout the year instead of one big chunk up front. Direct Debit uses an electronic transfer from your bank account, which means you don’t waste time writing a check or messing with stamps and envelopes.

You choose a timeline for electronic transfers from your account.

  • Monthly Schedule: debits your account for $16.70 twelve times a year*

  • Quarterly Schedule: debits your account for $50 four times a year*

  • *plus applicable processing fees

Special Disclosure Information: When your new membership year begins, your membership will AUTOMATICALLY be renewed unless we receive your cancellation in writing.
NPAM does not access your bank account. A private specialty firm directs your bank to send us the money automatically. If there are insufficient funds or a problem with transfer, membership will be suspended until dues and a $20 administrative fee are paid. If insufficient funds occur more than twice, your debit option will be canceled and you will need to choose another payment option for the remainder of your dues.

Regardless of when you join NPAM, direct debit payments are made on either the first or 15th of the month.

To set up Direct Debit, fill out the authorization form below and return it with a copy of your voided check.
Mail to NPAM at P.O. Box 540, Ellicott City, MD 21041-0540 or fax securely to 410-772-7915.

 


DIRECT DEBIT AUTHORIZATION FORM

  

THIS FORM CANNOT BE COMPLETED ONLINE AS YOU ARE REQUIRED TO ATTACH A COPY OF A VOIDED CHECK.

 


NPAM AUTHORIZATION AGREEMENT
DIRECT DEBIT (ACH DEBITS)


I (we) hereby authorize Nurse Practitioner Association of Maryland, hereinafter called COMPANY, to debit entries to my (our) account indicated below and the Financial Institution named below, hereinafter called FINANCIAL INSTITUTION, to debit same to such account. I (we) acknowledge the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.


__________________________________________________________________
(Financial Institution Name) (Branch)
 

_______________________________________________________________________________________
(Address) (City) (State) (Zip)
 

_______________________ ____________________________________
(Routing/Transit Number) (Account Number)
 

Type of Acct: ___Checking ___ Savings
 

Active Membership Recurring Set Amount: (Choose one)
 

_____Monthly - $16.70*       _____Quarterly - $50*     

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it. *plus applicable fees
 

_________________________________________
(Print Individual Name)
 

_________________________________________
(Signature)
 

_______________________
(Date)

PLEASE CLIP COPY OF VOIDED CHECK TO THIS FORM AND MAIL TO: NPAM PO BOX 540  ELLICOTT CITY, MD 21041-0540  OR FAX COPY OF FORM AND VOIDED CHECK TO 410-772-7915.  MEMBERSHIP CANNOT BE COMPLETED WITHOUT OUT A COPY OF YOUR CHECK.
 

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