ACH - RAFA Marketing

REQUEST FOR ELECTRONIC DEPOSIT (ACH)

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Company Name *

Email *

Phone Number *

Bank Name *

ABA Routing Number *

Account Number *

Upload "VOIDED CHECK" Image *

Max file size: 20MB

Account Type *

Checking Account Savings Account

DO YOU AGREE TO THESE TERMS? *

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By providing the information above you're giving LingoDocs, LLC (LingoDocs Marketing) authorization to charge the amount you agreed upon. If you're set up for "Automatic Recurring Payment", you're also giving us permission to use the information above to debit your account. This process may take a couple of days to be processed. Any "bounce backs" or "non-sufficient funds", a fee of $35.00 shall be paid by client. If you decide to cancel any recurring payments, you must provide cancelation in writing to [email protected], 30 days before next charged amount.

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