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Customer Authorization for Direct Payment Processing via ACH

Aaron Rittmaster

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Customer Authorization for Direct Payment Processing via ACH

13004 Knox St • Overland Park, KS • 66213 • (913) 660-0513 • aaron@fantasticmemoriestravel.com


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

I authorize Fantastic Memories Travel, LLC to process an electronic debit against my account as follows:

Vendor to receive payment: Scenic Luxury Cruises & Tours

Account Type (Select One)

 

at the depository financial institution named below. I agree that ACH transactions I authorize comply with applicable law.

  • Financial Institution Name:  
  • Account Holder Name:  
  • Financial Institution Routing Number:  
  • Account Number:  
  1. I affirm that I am an authorized party with regard to the above-referenced account.
  2. I understand that, by this authorization, I am explicitly directing Fantastic Memories Travel, LLC to process payments toward Cruise Booking #847613 using the information provided above.
  3. I direct Fantastic Memories Travel, LLC to process any payments due toward Cruise Booking #847613 at anytime within 5 days of a payment date required by Scenic Luxury Cruises & Tours, without any further instruction.
  4. This authorization will remain in full force and effect until I notify Fantastic Memories Travel, LLC in writing, via Email to aaron@fantasticmemoriestravel.com, with a Subject line including “ACH REVOCATION”, sent no less than seven (7) days prior to any scheduled payment.
  5. 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.

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Customer Authorization for Direct Payment Processing via ACH

Aaron Rittmaster

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