Web Payment by Check

PAY BY CHECK AUTHORIZATION

To ensure payment gets applied properly, please provide the following information:
Did you receive a letter from us?
See link above payment form to find out how to locate your Debtor ID # and / or Original Creditor
Debtor ID/Ref #
Original Creditor
Name on Account You are Paying

First NameLast Name
Type of Checking Account
Name exactly as listed on check
Amount you are paying
Check # (optional)
Bank Name
Bank City, State
Bank Routing #
9 - Digit Routing Number
Bank Account #
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Email Address
example@example.com
PAYMENT AUTHORIZATION

Type of Authorization
Type of Authorization
- Amount
- Date of Debit
  
  MonthDayYear
- Amount
- Frequency
  EX: Weekly, Monthly, Bi-Monthly - Specify Day of Week or Day of Month
- Start Date
  
  MonthDayYear
- End Date
  
  MonthDayYear
- EFT Authorization
- Authorization for Recurring or One-Time ACH Debit
  
  By signing below, you (“Customer” or “Authorized Signer”) authorize McKenzie Paul and Associates (“Company”) to initiate electronic debit entries to the bank account identified below for payment of goods and/or services provided by McKenzie Paul and Associates. You further authorize Unity FI Solutions, acting as Company’s authorized payment processor, to process these ACH transactions on Company’s behalf through the Automated Clearing House (“ACH”) network.
  
  You understand that this authorization permits Company and/or Unity FI Solutions to electronically debit the designated bank account for amounts owed according to the terms agreed upon between you and Company.
  
  TERMS & CONDITIONS
  1. Customer certifies that they are an authorized signer on the bank account listed above.
  2. Customer authorizes Company and Unity FI Solutions to debit the designated account for authorized payments and any applicable fees, adjustments, or returned item fees permitted by law and agreed upon with Company.
  3. Customer understands that ACH transactions may take several business days to process.
    Customer agrees to notify Company of any changes to banking information at least three (3) business days prior to the next scheduled payment.
  4. This authorization shall remain in full force and effect until revoked in writing by Customer and received by Company at least three (3) business days prior to the next scheduled debit.
  5. Customer acknowledges that revoking authorization with their financial institution without notifying Company may result in outstanding balances remaining due and payable.
  6. Customer authorizes Company and Unity FI Solutions to reinitiate returned ACH entries in accordance with applicable NACHA Operating Rules and applicable law.
  7. Customer acknowledges that payments processed through the ACH network are subject to the rules and regulations of NACHA and applicable federal and state laws.
- Digital Signature
  Please type your name to confirm that you have read the above statement and that you authorize McKenzie Paul and Associates to process the EFT as described above.
- Today's Date
  
  MonthDayYear
  Today's Date
- McKenzie Paul and Associates - Phone: (512) 420-0677 - Email: admin@mpanda.net
  
  Payment Processor: Unity FI Solutions
Should be Empty:

PAY BY CHECK AUTHORIZATION

PAYMENT AUTHORIZATION