Payment Authorization – SCG Accounting

Name *

First

Last

Phone

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Select Payment Option *

NOTE: Pay by bank Debit/e-Check/ACH option is only available for our payroll clients whose regular billing is through payroll accounting services.

Credit Card Number *

Expiration *

MM/YY

Security Code *

3 or 4 digit

Billing Zip Code *

Bank Name *

Routing Number *

Account Number *

E-Check/ACH Authorization/ Agreement *

I have reviewed and agree with the firm's billing and financial policy.
I authorize Shalom Consulting Group to draft my bank account in accordance with the terms of my agreement.
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Shalom Consulting Group in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. In the case of my card being declined or rejected for Non-Sufficient Funds (NSF), I understand that Shalom Consulting Group may at its discretion attempt to process the charge again within 30 days, and agree to any additional charges for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of electronic transactions must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute any charges in accordance with this authorization form and the firm's billing and financial policy.

Credit Card Authorization/ Agreement *

I have reviewed and agree with the firm's billing and financial policy.
I authorize Shalom Consulting Group to charge my credit account in accordance with the terms of my agreement.
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Shalom Consulting Group in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. In the case of my account returned or rejected for Non-Sufficient Funds (NSF), I understand that Shalom Consulting Group may at its discretion attempt to process the charge again within 30 days, and agree to any additional charges for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of electronic transactions must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute any charges in accordance with this authorization form and the firm's billing and financial policy.

Signature of Authroized Signer