Customer Purchase Order and Payment Authorization

 Customer Purchase Order and Payment Authorization Between    and   


Merchant Details: 



Customer Details:




Product/Service Description:   

Full Amount To Be Paid For Product/Service:   



Initial Deposit Processed By:   


Final Payment Due From Customer Upon Funding Of The Loan:

Final Payment Processed By:

Customer Bank Account Details (for funds to be paid as per this Purchase Order): 

Please provide the banking information for the account which the loan proceeds will be deposited:

Bank Name:   

Account Holder Name:   

Transit/ABA Routing Number (9 Digits):  Account Number:   


PAYMENT AUTHORIZATION: I authorize Flexxbuy LLC or its designated agent(s) (hereafter Flexxbuy) to transact and process the amount required  as indicated above. This authorization shall remain in effect until Flexxbuy concludes its responsibilities as indicated or receives a notice from me by email to info@flexxbuy.com stating that the Payment Authorization is cancelled.

How it works: As detailed in this Agreement, Flexxbuy will process a check draft from your account to the business/merchant for the purpose of completing your purchase. The check draft will be emailed to the business/merchant and deposited into their account.  If you need to change or cancel a transaction at any time prior to the check draft, simply email Flexxbuy at info@Flexxbuy.com or call, 866-343-5268. 

I understand that at no time will Flexxbuy ever be in possession or hold funds from my account.  Flexxbuy's full responsibility is to facilitate a payment between myself and the business/merchant. As per my instructions, Flexxbuy will process a check draft, as per the information provided, and send said check to business/merchant.  Upon the clearing of the funds from my account or, upon the discretion of the business/merchant, the product/service will be fulfilled. Flexxbuy is not a party of this transaction. This payment facilitation is being provided to me and the business/merchant as a convenience and there is no cost to either party for this service.

I understand that I alone am responsible for any fees or costs associated with payments returned for non-sufficient funds (NSF) or any other reason.  Business/merchant, at its discretion may charge a service fee for payments returned for any reason or may cancel the transaction outright.

I represent and warrant that I am authorized to execute this payment authorization for the purpose of implementing this payment plan. I indemnify and hold Flexxbuy harmless from damage, loss or claim resulting from all authorized actions hereunder.

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Signature Certificate
Document name: Customer Purchase Order and Payment Authorization
lock iconUnique Document ID: 25727b51b67a08d4e899863bae7a9a0a4a7c3fef
Timestamp Audit
May 6, 2019 3:38 pm EDTCustomer Purchase Order and Payment Authorization Uploaded by Bob Lovinger - bobl@flexxbuy.com IP