Bank Transfer Authorization
If you would like to enjoy the convenience of automatic billing, simply complete the Checking Account Information section below and sign the form. All requested information is required. Upon approval, we will automatically debit your account for the amount indicated and your total charges will appear on your monthly statement. You may cancel this automatic billing authorization at any time by contacting us.
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Email *
Client Business Name *
Phone Number *
Billing Address *
Billing City *
Billing Zipcode *
Account Number *
Bank Routing Number *
Account Type *
Amount to Pay *
Frequency *
Signature (Type your Full Name) *
By typing my full name, I certify that this is my electronic signature and have full signatory authority on the account above to enter into this billing agreement. I authorize Never Settle, S-Corp to electronically debit my bank account according to the terms outlined above. I acknowledge that electronic debits against my account must comply with United States law. This payment authorization is to remain in effect until I notify Never Settle, S-Corp of its cancellation by giving written notice in enough time for the business and receiving financial institution to have a reasonable opportunity to act on it.
Today's Date *
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