Authorization Agreement for Direct Payments

(ACH Debits or Paper Drafts)

Online form:

Or you can download the form:
ACH Bank Authorization Form

Return the downloaded form:

  • By Mail: PO Box 2445, Mendocino, CA 95460
  • By Fax: 707-937-0733
  • By Email: Send scan of completed form and voided check to
  • In Person to the MCN Office: 10700 Ford St. Mendocino CA 95460