Authorize ACH Payments for Legal Services

payment authorization

LYNX LEGAL SERVICE Authorization agreement for pre-arranged payments (ACH)

I hereby authorize Lynx Legal Service , hereinafter called company, to electronically debit the account indicated below, and if necessary, electronically credit the account.

payment type

Debit: Debit is for a single one-time entry or:

Recurring: Recurring entries that reoccur at regular intervals without any affirmative action required to initiate future entries.

Type of account

Checking

Savings

Bank Name

Routing Number

Bank Account Number

First Payment Amount

on {Date}

Subsequent Payment Amount

Number of Payments

Please enter a number from 1 to 10.

Total amount of all payments.

Subsequent payments to be debited every ( ? ) days from date of First Payment, until total above is paid

Please enter a number from 1 to 31.

Type Name to sign

First Last

Date

CAPTCHA

payment authorization

LYNX LEGAL SERVICE Authorization agreement for pre-arranged payments (ACH)

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