Pay Authorization

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Billing Information

Applicant's Name

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

** A valid credit card must be on file before Audio Dynamics will accept ACH as your primary form of payment. One order must be successfully processed with the valid credit card before ACH can be implemented for future orders. 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.**

Click or drag a file to this area to upload.
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