Phone: 626-462-9100

Fax: 626-551-3109

E-mail: info@budgetbookkeeping.net

50 E. Huntington Drive

Arcadia, CA 91006

www.budgetbookkeeping.net

Budget Bookkeeping & Income Tax Service

AUTOMATIC PAYMENT AGREEMENT

 

I, officer/owner of __________________________________________________ authorize Budget Bookkeeping & Income Tax Service and the financial institution named below to initiate entries to my checking/savings account or charge my credit card listed below. Budget Bookkeeping & Income Tax Service is authorized to initiate this transaction in payment of the account setup charge and monthly service charge indicated below.

 

Automatic Payments will be made on or about 15th of each month starting in the month of ____________ and ending in the month of ______________________ in the amount of $___________ per Month Quarter 6 Months Year for my Monthly Quarterly 6 Months Annually bookkeeping service.

 

Signature_________________________________________________                    Date _____________________________________

 

Print Name _______________________________________________

 

Bank Draft Option: I agree that Budget Bookkeeping & Income Tax Service may automatically issue a direct payment from my bank account in the agreed amount as indicated in service agreement. I can cancel this automatic payment at any time by advising Budget Bookkeeping & Income Tax Service of my change in payment method and completion of associated documentation. This authority will remain in effect until I notify Budget Bookkeeping & Income Tax Service in writing to cancel it in such time as to afford the financial institution a reasonable opportunity to act on it. I can stop payment of any entry by notifying my financial institution 3 days before my account is charged.

 

Name of Financial Institution

 

__________________________________________________________________________________________________________

Name—Please Print

 

__________________________________________________________________________________________________________

Address—Please Print

 

__________________________________________________________________________________________________________

Account No.          Checking / Saving (Please circle one)

 

__________________________________________________________________________________________________________

Financial Institution Routing Number (Please attach a void check)

 

Credit Card Option: I agree that Budget Bookkeeping & Income Tax Service may automatically charge my credit card account in the agreed amount as indicated in service agreement. I can cancel automatic payment at any time by advising Budget Bookkeeping & Income Tax Service of my change in payment method and completion of associated documentation. This agreement remains in effect until cancelled by Budget Bookkeeping & Income Tax Service, my bookkeeping service company or me.

 

__________________________________________________________________________________________________________

Credit Card #                                                                                                                              Exp. Date

 

__________________________________________________________________________________________________________

Credit Card Holder’s Name                                                                                                

 

__________________________________________________________________________________________________________

Credit Card Holder’s Signature

 

__________________________________________________________________________________________________________

Billing Address                                                                                                                           City                                           Zip Code