E-Refund Authorization

I hereby authorize in accordance with the rules and regulations of the National Automated Clearinghouse Association (“NACHA”), Lakeshore Technical College (LTC) to credit any reimbursements or refunds due to me via automated clearinghouse electronic fund transfer (“ACH”) to the bank and bank account referenced and owned by me. Further, I hereby authorize LTC to withdraw funds from the referenced bank account owned by me via ACH debit for the explicit purpose of correcting processing errors. Such debits are authorized only to perform legitimate and appropriate financial transactions between me and LTC. This authorization will remain in effect until cancelled. I will update my information if I change my bank account, close my bank account, or change financial institutions. I understand that LTC cannot access my banking information and does not have the capability to manipulate my bank account information.

Note: I understand that the Lakeshore Technical College requires up to two (2) business days to process this authorization and one (1) business day for funds to become available following an ACH electronic funds transfer.

Privacy Notification

The Family Educational Rights and Privacy Act of 1974 require the College to provide the following information to individuals who are asked to supply information about themselves. The principal purpose for requesting information on this form is to acquire authorization for reimbursement and refund distribution to a financial institution of the individual's choosing. Furnishing all information on this form is mandatory. Failure to provide such information will delay or may even prevent completion of the action for which the form is being submitted.

WTCS New North