ACH PAYMENT Today's Date(Required) MM slash DD slash YYYY Name of Authorizer(Required)Company Name (if applicable)(Required)Account Type(Required)CheckingSavingsAmount(Required)Is this a recurring charge?*(required)(Required) Yes No Signature(Required)Consent By signing and submitting this form I hereby authorize Home Automation Hawaii to process our payments via ACH for the agreed upon amounts.If the payment due date falls on a weekend or holiday, I understand and agree that the payment may be executed on the next business day. I understand and agree that as this is an electronic transaction, adequate funds must be available for withdrawal from my account by the payment due date. In the case of an ACH transaction being rejected for Non Sufficient Funds (NSF), submission error, or other bank related return reasons I understand and agree that the company may at its discretion resubmit the ACH debit transaction within thirty (30) days. I also understand and agree that a return item charge may be assessed for each returned ACH debit. I acknowledge that the origination of ACH transactions to my account must comply with provisions of U.S. law and agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.
