Payment Authorization Form
PLESE CONTACT YOUR CUSTOMER SERVICE REPRESENTATIVE PRIOR TO COMPLETING THIS AUTHORIZATION FORM
I authorize Oliphant USA, LLC to charge my bank account with the first payment and subsequent payments, at the amounts indicated, as further provided below.
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Oliphant USA, LLC in writing of any changes in my account information or termination of this authorization at least ten (10) days prior to the next billing date. If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF), I acknowledge that the Origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.