Recurring Payment Authorization Form

Schedule your payment to be automatically deducted from your bank account. Just complete the information below and submit, then draw your signature in the signing field. That’s it!

Recurring Payments Will Make Your Life Easier:

  • It’s convenient (saves you time and postage).
  • Your payment is always on time (even if you’re out of town), eliminating late charges.
  • It’s SAFER than using paper checks, which are handled at least 6 times before they are cleared.

Here Is How Recurring Payments Work:

You authorize regularly scheduled charges to your checking/savings account or credit card. You will be charged the amount indicated for each billing period. A receipt for each payment will be emailed to you and the charge will appear on your bank statement as an “ACH Debit.” You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.


 Please complete the information below: