1. Please complete/review the form by printing legibly with a dark pen or by typing directly onto the form.
    2. Sign with the account holder’s signature on the line indicated.

    I, , hereby authorize BlueSky Capital Funding LLC to charge my Bank Account in the amount of % of the funding amount as a consulting fee
    Type of Account:Checking AccountSaving Account
    Account #
    Account Routing #
    Bank Name #
    Checking/Saving Account Billing Address
    City: , State: Zip Code:
    As the account holder, I hereby authorize the above charge(s)
    Account Holder Signature

    Your completion of this authorization form helps us to protect you, our valued customers, from fraud.
    All information entered on this form will be kept strictly confidential by BlueSky Capital Funding LLC.