ACH Recurring Payment Authorization Form

Returns Solutions, 9570 Long Road, Ostrander, OH 43061

Here’s How Recurring Payments Work

You authorize regularly scheduled debits to your checking account. Your account will be debited the amount indicated on this authorization form. Complete and sign this form to get started. This authorization is to remain in full force and effect until Returns Solutions has received written notification from me (or any authorized account signer) of its termination in such time and manner as to afford the Company and Financial Institution a reasonable opportunity to act on the request.

Please complete the information below:

I (We) hereby authorize Returns Solutions, hereinafter called "Company", to initiate debit entries to my (our) account indicated below in the amount of $99.99 per month and the financial institution named below, hereinafter call "Financial Institution", to debit the same to such account. I (We) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. Law.

PLEASE ATTACH COPY OF VOIDED CHECK

This document must be filled and submitted by customers requesting automatic debit of payments and is retained by the Company.

Account Type: Checking

Terms and Conditions: I understand and agree that any changes in my account information, including a request to terminate the lease agreement, must be in writing and be delivered to the Company, at the above address, at least 21 days before the next due date. If the payment due date falls on a weekend or holiday, I understand and agree that the amount 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 understand and agree that, in accordance with the documents, a 10% late charge will be assessed if the amount due is not received in good and collected funds by the end of the grace period. 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 transaction 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.