ACH Filing Form – STRATEGIC BUSINESS CREDIT CONSULTING CORP

Payment Authorization Form

You authorize monthly charges of your choice of payment method by signing this form. The ACH transaction is governed by NACHA rules and regulations. You will be charged the amount indicated on your monthly invoice (which may vary upon usage) in each billing period. A receipt for each payment will be provided to you, and the charge will appear on your bank statement. Please complete all the fields below under billing information and Bank details.

I authorize Strategic Business Credit Consulting Corporation to charge my method of payment indicated below each month for the amount specified (may vary) on my bill each billing cycle.

Billing Address

Phone #

City

State

ZIP

Please select a payment method

ACH

Bank Account Type

Checking Savings

Account Name

Bank Name

Account Number

Routing Number

I understand that this authorization will remain in effect until I cancel it in writing by contacting Strategic Business Credit Consulting Corporation at 1-866-391-6303 or emailing Admin@SBCCCorp.com, and I agree to notify Strategic Business Credit Consulting Corporation via in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above-noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I certify that I am an authorized user of this payment method and will not dispute these scheduled transactions with my bank, so long as the transactions correspond to the terms indicated in this authorization form. I understand that any declined transaction or payment will result in an additional $20 fee. I understand that my information will be saved to file for future transactions on my account.

I accept and understand the terms of this agreement.

Todays Date

Signature Upload

E-Signature

Please note that this data is not saved on our servers for security purposes. You must submit your signature as part of the form before we can access it.

Payment Authorization Form

E-Signature

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