Introducing...NPAM Direct Debit
You decide.....
Your NPAM dues payments are paid in increments throughout the year instead of one big chunk up front.
Your NPAM dues are paid by electronic transfer from your bank account which means you don't waste your time writing a check.
Your NPAM electronic payments mean you don't mess with stamps or 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.
Annual Schedule: automatically debits your account for the full balance of $200 for the year.
Special Disclosure Information: When the new membership year begins, your membership will AUTOMATICALLY be renewed unless we hear from you in writing before the June 30 renewal date asking that it be canceled.
NPAM does not access your bank account. A private specialty firm directs your bank to send us the money automatically. If there is insufficient funds or a problem with transfer, membership will be suspended until dues, and a $20 administrative fee are paid. Insufficient fund notices more than twice will automatically trigger closure and suspension of your direct debit option and you will need to choose another payment option for the remainder of dues.
Regardless of when you join NPAM, direct debit payments are made on either the 1st or 15th of the month.
To set up your Direct Debit contract with NPAM simply fill out this authorization form below and return it with a copy of your voided check.
Mail to NPAM at PO Box 540 Ellicott City, MD 21041-0540 or Fax to our secure fax at 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 ______Annual - $200
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.
_________________________________________
(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.
