ResortInternet - Pre-Arranged Payment Authorization Form (ACH)

ResortInternet - Pre-Arranged Payment Authorization (ACH) Form

Customer hereby authorizes ResortNet LLC, dba ResortInternet to withdraw amounts including any and all Internet service, satellite television service, VOIP phone service, or any other related charges associated with the Internet/TV/Phone services provided, including service calls, equipment replacement due to damage/theft and all associated sales/use taxes. In the event there are insufficient funds, ResortInternet will impose an NSF fee of $35.00. It is the sole and express responsibility of the Customer to provide another form of payment if the account is closed for any reason. Failure to provide payment for services provided will constitute a breach of this agreement and ResortInternet has the authority to proceed with all necessary collection requirements including reporting of account status to a credit agency, turning the account over to a third-party collection agency, and or legal proceedings as allowed by Colorado Statutes and laws. This agreement will remain in effect until written notification is provided to accounting@resortinternet.com requesting termination of this agreement.

Please select one of the following as your monthly ACH processing date or as a one time payment.

10th of each month 20th of each month One Time Payment

Email address

Your First & Last Name

Name(s) on Bank Account (business name if used)

Check Example

Bank Name

Routing Number

Account Number

Bank Branch Phone Number

Date

By submitting this form, I acknowledge that I am the legal account holder, or have express authorization to enter into this agreement for ACH withdrawals from my/our bank account. I authorize ResortInternet to withdraw funds each month equal to my monthly invoice amount. This authorization is to remain in force until the company receives my termination notice.

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