Authorization for ACH Payment Processing

Fantastic Memories Travel • 13004 Knox St • Overland Park, KS • 66213 • (913)660-0513

By completing this form, you give permission for your Fantastic Memories Travel professional to use the information you provide to make payments for your vacation plans with travel suppliers on your behalf. ACH Payment Processing transfers funds directly from your account to the supplier. All payments are subject to Fantastic Memories Travel, LLC Terms & Conditions, as well as any travel supplier-provided Terms & Conditions.

I authorize Fantastic Memories Travel to process electronic debits using the account information I provide. Payments may be made (Select One):toward any balance due on the invoice indicated below.ONLY toward amounts due to the specific supplier indicated below.

Identify EITHER the Invoice # ("INV-Unique Identifier") or Supplier

Maximum Amount Authorized:

Payment Account Information

Account TypeChecking AccountSavings Account

• Name on Account:
• Financial Institution Name:
• Routing Number:
• Account Number:
• Billing Address Line 1:
• Billing Address Line 2:
• City:  State:
• ZIP Code:

1. I affirm that I am legally permitted to make decisions and give direction with regard to the financial account information provided.
2. I understand that, by this authorization, I am explicitly directing Fantastic Memories Travel, LLC to process payments from my account indicated above.
3. I understand that payments will be processed in accordance with payment due dates communicated to me on my Fantastic Memories Travel electronic invoice. Payments may be processed at any time within 5 (five) calendar days of a specified payment date, without any further instruction or consent.
4. This Authorization will remain in full force and effect until I notify Fantastic Memories Travel, LLC of revocation. Revocation shall be provided in writing, via Email, to my Fantastic Memories Travel professional of record, and copied to aaron@fantasticmemoriestravel.com, with a Subject Line that includes, "ACH REVOCATION."
5. Revocation notices received less than seven (7) days prior to a scheduled payment may not take effect until after such payment is processed.
6. I agree to the use of electronic signatures to execute this authorization, and agree that my electronic acknowledgment of this authorization shall have the same force and effect as a handwritten signature.