Business Finance ACH Authorization Form

BUSINESS FINANCE ACH AUTHORIZATION FORM

This Business Finance ACH Authorization Form (the Agreement) is entered into by the parties identified below to authorize automated clearing house (ACH) electronic debits and/or credits to the designated account for payment of financial obligations described herein.

PARTIES

RECITALS

WHEREAS, Customer and Payee desire to set forth the terms under which Customer will authorize ACH debits and/or credits to Customer's designated bank account for payment of amounts due for goods, services, finance charges or other obligations incurred by Customer; and

WHEREAS, Customer represents that it is the lawful owner (or an authorized signer) of the designated bank account and has authority to provide this authorization; and

WHEREAS, the parties intend this Agreement to constitute a binding authorization and payment agreement subject to the terms set forth below.

SCOPE OF WORK

PAYMENT TERMS

Amount Authorized for ACH Transactions: $    Frequency / Schedule:

If amount is variable, maximum single debit authorized (if applicable): $

Late Payment Fee (if payment is not authorized or returned):

ACH ACCOUNT INFORMATION

Account Type: Checking Savings

Attach a voided check or bank letter when submitting this form to verify account ownership and routing details. The undersigned authorizes electronic debits and/or credits as detailed in this form.

AUTHORIZATION

Customer hereby authorizes Payee, its agents and designees to initiate ACH entries to the account provided above for the purpose of collecting payments due under this Agreement, including any fees permitted hereunder. This authorization permits debits and/or credits as indicated and shall remain in effect until terminated in accordance with the Term and Termination provisions below.

Customer represents and warrants that all information provided is true and correct and that Customer is authorized to allow debits/credits against the referenced account. Customer agrees to notify Payee in writing at least 30 days prior to any change in banking information. Payee may rely upon this authorization until receipt of such written notice and a reasonable opportunity to act.

REVOCATION, RETURNS, AND INDEMNITY

Revocation: Customer may revoke this authorization only by providing written notice to Payee at the Payee address specified above and allowing a reasonable period for Payee to act on such notice. Revocation does not affect debits already processed in good faith.

Returned Items and Liability: If an ACH entry is returned for any reason, Customer will remain liable for the payment, plus any returned-payment fees, applicable late fees, and reasonable costs of collection. Customer agrees to indemnify and hold Payee harmless from any losses, claims, damages, or expenses arising from inaccurate or unauthorized account information provided by Customer, except to the extent caused by Payee's gross negligence or intentional misconduct.

TERM AND TERMINATION

Effective Date:    Termination Date:

Either party may terminate this Agreement for convenience upon written notice to the other party no fewer than days prior to the intended termination date. Termination will not relieve Customer of obligations for amounts already accrued or debits already authorized and presented to Customer's bank.

CONFIDENTIALITY

Both parties agree to maintain the confidentiality of bank account numbers, routing information, transactional records, and any non-public financial terms disclosed in connection with this Agreement. Confidential information shall not be disclosed except as required by law, to enforce rights under this Agreement, or to financial institutions necessary to process ACH transactions.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state of without regard to conflict of laws principles.

ENTIRE AGREEMENT

This Agreement constitutes the entire understanding between Customer and Payee with respect to the subject matter herein and supersedes all prior oral or written agreements. Any modification must be in writing and signed by authorized representatives of both parties.

REPRESENTATIONS AND CERTIFICATIONS

By signing below, the undersigned certifies that they are an authorized representative of the Customer or Payee (as applicable), and that the information provided on this form is true and correct. The undersigned further certifies that they are authorized to execute this ACH authorization on behalf of the entity identified.

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