ACH Payments Twin Oak CDC

We are excited to offer the safety, convenience, and ease of automated payment processing that allows secure, on-time payments to be made from either your bank account or credit card. Please note there is an additional 3% charge for credit card payments.

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT

I (we) hereby authorize Source One Video, Inc. dba KidsVision to initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit union members: please contact your credit union to verify account and routing numbers for automatic payments.
Location Name *
Today's Date Today's Date * / MM / DD YYYY
Amount Charged $ Dollars . Cents
BANK ACCOUNT

You must complete all Fields in this section .
Your Name *
Email *
Phone Phone * - ### - ### ####
Business Address Business Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
EIN# or SS# *
Bank or Credit Union Name *
Bank or Credit Union Address Bank or Credit Union Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
See Check for Placement of Numbers
Account Type *

Account Type Checking Savings
Routing Transit Number (see sample above) *
Account Number (see sample above) *
Please upload a picture of a voided check

Attach Files

If you are having an issue with a mobile upload, save the file first to your camera roll before attempting to upload to our servers.
I agree to the following: *

I agree to the following: There is a $50.00 overdraft fee. Your service will not be restored until this fee. You are responsible for any Collections or Attorney fees if we are forced to send your account to collections. Regardless of your location, any disagreements regarding any terms of this contract will be litigated in Madison County, Mississippi.
Draw your signature into the box below indicating your agreement: *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

ACH Payments Twin Oak CDC

ACH Payments Twin Oak CDC

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT

BANK ACCOUNT

See Check for Placement of Numbers