Flexxbuy Payment Authorization Agreement
Utilize this Payment Authorization For All Future Fees, In Addition To This One, To Be Collected: YesNo
Payment MethodDebit/Credit CardChecking Account
IF PAYING THROUGH CHECKING ACCOUNT:
IF PAYING BY DEBIT/CREDIT CARD :
PAYMENT AUTHORIZATION: I authorize Flexxbuy LLC or its designated agent(s) (hereafter Flexxbuy) to transact and collect the amount required as indicated above using the method indicated on this Payment Authorization. This authorization shall remain in effect until Flexxbuy receives a 30-day written notification from me of intent to terminate in such manner as to afford Flexxbuy reasonable opportunity to act. I understand that Termination does not alter any amount due Flexxbuy through results achieved prior to termination and this Payment Authorization Form will remain in effect until such amount is paid in full. Any changes, such as change in bank and/or bank account number will require a new Payment Authorization Form to be executed and submitted to Flexxbuy 15 days prior to any change being implemented. I understand that this payment plan may be canceled by Flexxbuy due to non-sufficient funds (NSF). In the event my account does not have sufficient funds for the payment and the payment is returned, I will be liable to pay an NSF fee of $25 per occurrence (or the amount allowed by law) which may be automatically debited for each NSF or attached to the payment attempt made by Flexxbuy. 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 and the bank(s) harmless from damage, loss or claim resulting from damage, loss or claim resulting from all authorized actions hereunder.
I agree to all other Program fees as described in the Merchant Application and/or Agreement.
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Document Name: Flexxbuy Payment Authorization Agreement
Agree & Sign