Payments by Credit Card. Last Four Digits of Card Number: Full credit card numbers are not to be written on this form. Please hand your card to the cashier or call our customer service office to provide the credit card number. Payments by Bank Account: Name of financial institution: . Select One: Checking Account You are required to submit an original voided check with this authorization agreement. There must be a transit routing number and account number on the check. Savings Account – You are required to submit an original voided deposit slip with this authorization agreement. There must be a transit routing number and account number on the slip. If the voided check or voided deposit slip does not include a transit or account number, please obtain this information from your financial institution before you submit this form. The transit or account number must be submitted with this authorization. I agree to and understand the following terms: The Town of Jupiter has the right to discontinue the Pre-Authorized Payment Plan if any two or more deductions are not honored. Town of Jupiter will automatically debit my bank account or credit card noted above approximately 15 days following the BILL DATE of my monthly utility bill. I understand it is my responsibility to ensure funds are available in my bank account. I understand I must pay all bills issued until such time that my utility bill indicates “Autopay – Do Not Pay”. I understand if my bank account institution or credit card number changes or my bank account is closed for any reason, I will be responsible for notifying the Town of the new account number and if applicable I will be responsible for all return draft charges. For Tenants only I understand that because the account remains in the owner’s name, it is my responsibility to notify the Town should I want to discontinue pre-authorized payments. Refunds will not be provided. Print Name on Bank Account or Credit Card
Payments by Credit Card. If Company pays with a credit or other payment card, it will be required to provide Nord Signum’s third- party payment processor with a valid payment card number and associated payment information verifying Company is authorization to use such payment. By submitting that information to the third-party payment processor, Company authorizes Nord Signum and or the payment processor to charge the card or other payment method for the charges incurred with Nord Signum. The third party payment processor may run one or more payment card authorization checks on Company’s card before it is charged. Company authorizes the third-party payment processor to store Company’s payment card information and, if needed, to continue billing the card until the order for Nord Signum services has been fulfilled. If Nord Signum does not receive payment from Company’s credit card or other payment card issuer or their agents, Company remains obligated and agrees to pay all amounts due upon request from Nord Signum or its agents.
Payments by Credit Card. If Company pays with a credit or other payment card, it will be required to provide AdsWizz’s third-party payment processor with a valid payment card number and associated payment information verifying Company is authorization to use such payment. By submitting that information to the third-party payment processor, Company authorizes AdsWizz and or the payment processor to charge the card or other payment method for the charges incurred with AudioGo. The third party payment processor may run one or more payment card authorization checks on Company’s card before it is charged. Company authorizes the third-party payment processor to store Company’s payment card information and, if needed, to continue billing the card until the order for AudioGo services has been fulfilled. If AdsWizz does not receive payment from Company’s credit card or other payment card issuer or their agents, Company remains obligated and agrees to pay all amounts due upon request from AdsWizz or its agents.
Payments by Credit Card. Check the box online that affirms that you have read and accept the terms of the partial pay agreement and submit the first payment online. VanEd will automatically charge additional payments to the student’s credit card at 30 day interval(s) as agreed. **IF YOU COMPLETE YOUR ENROLLMENT & PAY ONLINE, YOU DO NOT NEED TO RETURN THIS FORM; IT IS AUTOMATED ONLINE**
Payments by Credit Card. ADVERTISER agrees not to, directly or indirectly, cause or permit amounts funded to ADVERTISER’s Account to be charged-‐back by the credit card company through which the Account was funded.
Payments by Credit Card. 9.1. In the event a new Service is ordered by the Customer with payment via credit card, this credit card information may be stored against on the Customer's Account and may be used for future automatic invoice payments. Together Technology engages PayPal for all card transactions, and they manage storage and security of payment information. At no time does your financial information get stored on our servers.
