ERP & CRM Blog One Time Permission & Recurring ACH Payment Authorization

Company Name & Authorized Administrator Info

Company Name *

Authorized Banking Administrator Full Name *

Authorized Administrator Email *

Authorized Administrator Phone Number *

Bank Name and Account Details

Bank Name (US Banks Only) *

Bank Account Name *

Routing Number *

Re-Enter Routing Number *

Bank Account Number *

Re-enter Bank Account Number *

Billing Frequency

Please Charge Me: *

Notes and Comments:

By signing below I, the company administrator entered above, authorize charges to my company’s checking account. If agreeing to monthly billing my company will be sent an invoice three days prior to the ACH transaction. Transactions will be withdrawn from our bank unless I or another company representative disputes the charges shown on the invoice. Undisputed charges will appear on your bank statement as an “ACH Debit” from ERP Software Blog LLC,

These payments to ERP Blog LLC are for blog membership fees and other requested services such as customization of whitepapers and blog rewrites.

I understand that this authorization will remain in effect until I or another representative of my company cancels this ACH permission by sending an email to accounting@erpsoftwareblog.com and then receives a confirmation email in return.

I further certify that I am an authorized administrator of this bank account.

Company Banking Administrator Signature *

clear

Today's Date * +