eCheck Authorization Form

eCheck Authorization Form Instructions

Please print out the form by clicking on the "gear" drop down menu below, where there is a print option.  Once you have it printed out, fill out the eCheck Authorization Form. Then fax it to 231-480-4080 or deliver it to our office at 393 N. Amber Rd., Scottville, MI 49454. Our bank will submit your payment authorization to your bank.  Thank you for signing up for eCheck payments.

Authorization Agreement For eCheck (ACH) Payments


I hereby authorize SyncWave, LLC to initiate monthly debit entries in payment of my SyncWave, LLC internet subscription, to my account indicated below at the bank/depository named below.  In addition, I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.
I further understand that if I wish any withdrawals in payment of any invoices other than my monthly subscription, I will notify SyncWave, LLC of the date I want the withdrawal done, and the amount I want withdrawn.  Repair invoices maybe paid through ACH, but not without my express instructions.

Bank/Depository Name ________________________________________________
Bank/Depository City ____________________ State ________ Zip _____________
Routing Number __________________________________
Account Number __________________________________
Checking ____        Savings ____   (indicate one only)
Automatic Recurring Payments ____        On Request E-Checks ____ (indicate one only)

This authorization is to remain in full force and effect until SyncWave, LLC has received written notification from me of its termination in such time and in such manner as to afford SyncWave, LLC and the Bank\Depository a reasonable opportunity to act on it.

Your Name (Please Print) __________________________________________________
Name on your SyncWave Account : _____________________________________

 

Signature __________________________________ Date _________________
 

Note: Written Debit Authorizations must provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.

SyncWave Payments