Pay Authorization

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Billing Information

Dealer Status
Applicant's Name
Shipping Address

Authorized Payment Types (check all that apply)

Authorized Payment Types

** ACH payments earn an extra 1% discount

Primary Form of Payment (check one)

Primary Form of Payment

** ACH payments earn an extra 1% discount

Direct ACH Payment Information (Preferred) – Earns an extra 1% discount

Direct Payment via ACH is the transfer of funds from a business’ bank account for the purpose of making a payment.

I (we) authorize Audio Dynamics to electronically debit my (our) account (and, if necessary, electronically credit my (our) account to correct erroneous debits*), and/or charge my (our) credit/debit card.

Amount of debit(s) or method of determining amount of debit(s) [or specify range of acceptable dollar amounts authorized]: By verbal agreement.

Date(s) and/or frequency of debit(s): By verbal agreement.

I (we) understand that this authorization will remain in full force and effect until I (we) notify Audio Dynamics in writing that I (we) wish to revoke this authorization. I (we) understand that it requires at least 5 days prior notice in order to cancel this authorization.**

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Authorized Date

* The NACHA Operating Rules do not require the consumer’s express authorization to initiate Reversing Entries to correct erroneous transactions.

** Written debit authorizations must provide that the Receiver may revoke the authorization only by notifying the Originator in the time and manner stated in the authorization. The reference to notification should be filled with a statement of the time and manner that notification must be given in order to provide company a reasonable opportunity to act on it