Bank Transfer (ACH) Authorization Form

Customer Information:
Billing Address:
Terms of Billing:

Monthly Recurring Payment

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The payment authorization is to remain in effect until I,                                                                                     notify Cloudfire LLC of its cancellation by giving written notice in enough time for the business and receiving financial institution to have a reasonable opportunity to act on it.

Please read the terms and conditions below and check the box to accept:

I understand that there will be a $1.94 per ACH transaction fee added for each payment made via ACH. Furthermore, I give permission and authorize Cloudfire LLC to add said $1.94 transaction fee to each transaction in addition to the amounts listed above.

By typing your name below, you are signing this form electronically. You are the person that you say you are
signing for. You agree your electronic signature is equivalent to your manual signature on this form.

Signature:

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