Name: Art Unlimited
Address: 9998 E. Lind Rd., Angora, MN, 55703
Telephone: 218-666-2512
Price range: $$
Rating: 5.0

I authorize Art Unlimited 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.
Please indicate your Terms of Billing below:
Start Billing Date:*
Date Format: MM slash DD slash YYYY
End Billing Date:*
Date Format: MM slash DD slash YYYY
Invoice Number
Day of the Month Billing (Please select one if applicable):
- 1st of the month
- 15th of the month
- One Time Payment
Amount to be processed:*
Bank Information:
ABA Number [Customer's Routing Number]:*
Bank Account Number [Customer's Account Number]:*
Bank Account Type: [Checking/Savings/Business Checking]
- Checking
- Savings
- Business Checking
This payment authorization is to remain in full force and effect until I, notify Art Unlimited of its cancellation by sending written notice in such time and in such manner to allow both Art Unlimited and the receiving financial institution a reasonable opportunity to act on it.
Name
First Last
Business Name
Business Address
Street Address City State ZIP Code
Email
Phone
Signature
Customer Printed Name
Date
Date Format: MM slash DD slash YYYY

ACH / e-check