ACH / e-check |

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:*

End Billing Date:*

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

ACH / e-check

ACH Form