Payment eCheck - Las Vegas, Paradise, Henderson

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I authorize NetEffect, LLC to initiate either an electronic debit or to create and process a demand draft against my bank account according to the terms outlined below. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law, and will be in accordance with the billing date and terms on the corresponding agreement with NetEffect, LLC.
Terms of Billing
Hidden
Beginning on the 25th of the current month, and the 25th of every month thereafter.
Beginning on the 25th of the current month, and the 25th of every month thereafter.
MM slash DD slash YYYY
Beginning on the 25th of the current month, and the 25th of every month thereafter.

And recurring on or near the same day of each month.
- No end date specified at this time.
- Ending on
Date
MM slash DD slash YYYY
Please add amount in dollar here*
for the amount of
The recurring dollar amount will increase and decrease strictly in accordance with the terms of the Agreement which has been executed by both parties.
Bank Information
Bank ABA Routing Number:*
Bank Account Number:*
Bank Account Type:*
*
- By entering my printed name and date below, I am accepting this as my digital signature and authorization to proceed as described above. I also stipulate that I have all necessary authorization from the company from which the debit or draft will be drawn.
Company Name
Printed name:*
Date Signed:*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

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Recurring Payments by eCheck

Terms of Billing

Bank Information