ach

PAY BY ACH OR E-CHECK

Bank Name:

Account type:

Routing #

Account #

Amount of debit authorized:

Dates and / or frequency of debits:

I AGREE TO THE FOLLOWING STATEMENT: By typing my name into the signature field below, I understand that this authorization will remain in full force and effect until I notify WZW Family Law by email at traci@wzwfamilylaw.com, that I wish to revoke this authorization. I understand that WZW Family Law LLC requires at least 5 days prior notice in order to cancel this authorization. Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment. I authorize WZW Family Law LLC to electronically debit and / or credit the account listed below. I agree that ACH transactions I authorize comply with all applicable laws.

Name:

Signature:

Date:

Your email: