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ACH Authorization Form

Kenneth Kirschenbaum, Esq., Tel. No. (516) 747-6700

KIRSCHENBAUM CONTRACTS® Copyright 4-20-2020

Licensed by the State of Florida, Dept. of Business & Professional Regulation

License No.: EG13000253

CASTLE PROTECTION & AUTOMATION LLC

8388 S. Tamiami Trail, Suite 60

Sarasota, Florida 34238

(866) 780-6981

ACH RECURRING PAYMENT AND CREDIT CARD AUTHORIZATION FORM

Here’s How Recurring Payments Work:

You authorize regularly scheduled charges to your checking, savings account, or credit card. You will be charged the amount indicated below each billing period during the initial term of my agreement and all automatic renewal terms. The charge will appear on your bank statement as an “ACH Debit” or your credit card statement. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

Please complete the information below:

authorize CASTLE PROTECTION & AUTOMATION LLC to charge my

Bank Account

Credit Card

indicated below on the

of each

for payment of my

In the amount of $:

Job Site Address:

Street:

Zip Code:

Email Address:

Unit #:

City:

Select payment method below:

AUTOMATED ACH FROM BANK ACCOUNT PAYMENT:

Account Type:

CheckingSavings

Name on Acct:

Bank Name:

Account Number:

Bank Routing #:

Bank City/State:

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify CASTLE PROTECTION & AUTOMATION LLC 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 above noted periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account, or charged to my credit card, on the above noted periodic transaction dates. In the case of a transaction being rejected for Non-Sufficient Funds (NSF) I understand that CASTLE PROTECTION & AUTOMATION LLC may at its discretion attempt to process the charge again within 30 days, and I agree to an additional $25.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of recurring transactions to my account must comply with the provisions of U.S. Law. I agree not to dispute this recurring billing with my bank or credit card company so long as the transactions correspond to the terms indicated in this authorization form. I agree that an ACH or credit card denial will constitute a breach of my payment obligation in my agreement with CASTLE PROTECTION & AUTOMATION LLC.

AUTOMATED CREDIT CARD PAYMENT:

Credit Card #:

Expiration Date:

Security Code:

MastercardVisaAmerican Express

Cardholder’s Name (As it appears on credit card):

Billing Address:

Street:

Unit #:

City:

Zip Code:

Email Address: