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Recurring Payment Authorization

Schedule your payment to be automatically deducted from your bank account, or charged to your Visa, MasterCard, American Express or Discover Card. Just complete and sign this form to get started!

RECURRING PAYMENTS MAKE YOUR LIFE EASIER:
It’s convenient (saving you time and postage).
Your payment is always on time (even if you’re out of town), eliminating late charges.

HOW RECCURRING PAYMENTS WORK:
You authorize regular/one-time scheduled charges to your checking/savings account or credit card. You will be charged the amount invoiced each billing period. A receipt for each payment will be emailed to you following each transaction.

PLEASE COMPLETE THE INFORMATION BELOW:

I authorize Fisher’s Technology, Inc. to automatically deduct electronic payments from my checking/savings account or credit card indicated below. Payments will be initiated automatically on the corresponding invoice date for the total amount due.
Company Name *
Company Number *
Billing Address *
Address Line 2 *
City *
State *
ZIP Code *
Email Address (for receipt and invoice) *
Phone Number *
Checking or Savings Account *
Account Name *
Bank Name *
Bank City *
Bank State *
Account Number *
Routing Number *
Credit Card *
Cardholder Name *
Account Number *
Exp. Date *
CVV *
Authorized Signature *
Clear
Date *
First Name *
Last Name *
Title *
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Fisher’s Technology, Inc. in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date. If the payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as invoiced. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that Fisher’s Technology, Inc. may at its discretion attempt to process the charge again and agree to an additional $15.00 charge for each returned NSF, which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form.