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ACH Payment Authorization You authorize regularly scheduled charges to your Checking Account. You will be charged the amount indicated below each billing period. The ACH charge will appear on your
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Specify the amount that will be charged and the reason for the charge.
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You will be charged for the services provided.
Anyone who has utilized the services.
You can fill out the form online or in person.
The purpose is to accurately bill for the services received.
Details of the services rendered and any applicable charges.
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