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Work Request
Association Name:

Full Name:

Address / Apt #:

Email:

Phone:

Name of Your Bank:

Account Number:

Homeowner Account Number:
(As listed on your assessment coupon)

ABA Number
(Always the 9 digits preceding your account #)

Checking Savings

This authorization will remain in effect until Wolin-Levin, Inc. or the bank has received written notification from me (or either of us) of its termination in such time and manner as to allow Wolin-Levin, Inc. and the bank reasonable opportunity to act on it

  • Your bank account will be debited on the (5th) fifth of each month for the invoice amount
  • It takes about (20) twenty business days to process your application; thus if we receive it by the (20th) twentieth of the month, it will take effect the following month
  • If the Direct Debit does not go through because of insufficient funds, you will be assessed a $50.00 failed transaction fee
  • If you wish to cancel your Direct Debit at any time, please notify us in writing (via fax at 312-335-1955 or email) by the 20th of the prior month

If you have any questions, please contact Sharon Giancola at 312-335-5683 or via email at sgiancola@wolin-levin.com OR Tracy Repsold at 312-335-5682 or via email at trepsold@wolin-levin.com. * If you change bank accounts, you must notify us in writing and send a voided check from your new account by email, fax or mail

We will notify you via email when your debit authorization will take effect. Until then, please continue to submit payments as usual.


This is my (our) authorization to debit my (our) account (checking/savings) for my (our) monthly fees. I (we) understand that my (our) account will be debited for the total amount on the fifth (5th) day of each month.