Payment Ongoing Authorization

PAYMENT ONGOING AUTHORIZATION

Payee (Merchant / Service Provider)

Payer (Account Holder)

Payment Authorization Details

I authorize Payee to initiate recurring debit entries to the account specified below for payment of amounts owed for the following purpose: Reference/Invoice/Description:

Start Date:     End Date (if applicable):     Or until:

Payment Method (select applicable)

Fees, Notices & Failed Payment Policy

Late Payment Fee (if applicable): or Interest at per month on outstanding balances.

Pre-Notice of Variable Amounts: Payer will receive advance notice of changes Method of Notice:

Terms and Conditions

Authorization: Payer authorizes Payee to initiate electronic debits and, if necessary, credit entries and adjustments for any erroneous debits to the account indicated. This authorization remains in effect until revoked in writing as set forth below. Payer certifies they are an authorized signer on the designated account.

Amount Changes: For fixed authorizations, Payee will obtain Payer's written consent for any increase in the regular debit amount. For variable authorizations, Payee will provide advance notice of any amount to be debited where such notice is required by agreement.

Cancellation / Revocation: Payer may revoke this authorization by providing written notice to Payee at the Payee Address or Payee Email listed above. Revocation is effective only after Payee has had a reasonable opportunity to act on it; Payer remains responsible for payments initiated prior to revocation. Timely revocation shall be provided no fewer than days prior to the next scheduled debit unless otherwise agreed.

Disputes: Payer must notify Payee of any disputed debit within a commercially reasonable time. Claims for unauthorized or erroneous debits must be made in accordance with the terms of the depository financial institution's rules and applicable law. Parties agree to cooperate in good faith to resolve any dispute.

Liability and Indemnification: Payer agrees to indemnify and hold Payee harmless from claims, losses, or expenses resulting from Payer's failure to provide correct account information or to maintain sufficient funds. Payee will not be liable for delays or failures caused by the depository institution or network interruptions beyond Payee's reasonable control.

Governing Law: This authorization and the rights and obligations of the parties shall be governed by the laws of the jurisdiction in which Payee is organized, except to the extent preempted by applicable federal law.

Acknowledgment

By signing below, Payer certifies that they have read, understand, and agree to this Payment Ongoing Authorization, and that the information provided is true and correct. Payer consents to electronic processing of payments according to the terms above and agrees that this authorization constitutes a legally binding signature.

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