Recurring Payment Authorization Form
Required payment method for monthly plans
WE WILL NOT CHARGE YOUR CAR UNTIL AFTER OUR FIRST MEETING
Complete the Additional Services and Credit /Debit card Information section below. All requested information is required. Upon approval, we will on the date listed below, automatically bill your credit card for the amount indicated and your total charges will appear on your monthly credit / debit card statement. You may cancel this automatic billing authorization at any time by contacting us. Any bank returned items or chargeback or NSF will incur a $25.00 fee. In addition, Intuit Merchant Services charges .0325 of all transactions balances. Unpaid balances will be automatically billed to the card listed until satisfied or until other arrangements have been made with our office.
I AUTHORIZE TAX AND ACCOUNTING SERVICES COMPANY / MARK TOUSSAINT TO AUTOMATICALLY BILL THE CARD
BELOW AS SPECIFIED FOR THE FOLLOWING AMOUNTS:
PRODUCT / SERVICE DESCRIPTION: FULL-SERVICE PLAN .
RECURRING AMOUNT: $379 .
FREQUENCY: MONTHLY ON 10TH DAY . STARTING NEXT 10TH DAY OF MONTH - END DATE: UNTIL CANCELLED .
QUICKBOOKS ADD ON SUBSCRIPTIONS WILL BE BILLED AT THE PRICE SET BY INTUIT.
PRICES ARE SUBJECT TO CHANGE BASED ON INTUITS TERMS AND CONDITIONS. WE WILL INFORM YOU OF THE CHARGE PRIOR TO CHARGING YOUR CEDIT CARD.
CREDIT CARD INFORMATION
COMPLETE THE FOLLOWING INFORMATION
Right click on the page to print this form before submitting