I as Customer of this Agreement understand and agree to the following terms:
1) I am responsible for the payment schedule as outlined above and I understand the terms & conditions outlined in the Practice’s Wellness Plan Agreement.
2) The EFT authorization is to remain in full force and effect until HHVC has received notification of its termination, as such time and such manner as to afford a reasonable opportunity to act on it. If the EFT authorization is cancelled, it does not release Customer from your obligation/agreement and/or any renewal options outlined in this Agreement.
3) I authorize HHVC to continually debit (for what is owed or any portion of the balance I owe) my accounts listed above and/or to any bank account changes or updates HHVC receives from me or my credit card company and/or the banking institution where my accounts reside until all my payments are current and/or the balance I owe is paid in full, including fees. Any payments made on this Agreement will be applied to any and all fees outlined in this Agreement first and any remaining portion will be applied to the outstanding balance.
4) A late charge of $10.00 per payment may be assessed if my payments are received in our office more than 10 days late and/or there remains and unpaid delinquent balance due to partial payments, unpaid payments and/or unpaid late charges, return fees or processing fees.
5) Customer may be charged up to $39.00 for returned checks and/or electronic returns due to insufficient funds, closed accounts, declines, etc.
6) I do not need a Federal Truth in Lending Disclosure Statement to understand the terms of this payment plan and the fees involved.
7) You are authorized to check my credit and employment history for the duration of this Agreement and to answer questions about your credit experience with me.
8) That my account may be sent to a credit reporting agency if it becomes delinquent.
9) I authorize the use of phone calls by computer or manually dialed to my home, work, and/or mobile phone, email notices, text messaging, social media messaging and paper notices for any and all ways to contact me in regards to this Agreement and/or my relationship with HHVC.
10) That I am responsible for court costs, private process service costs, pre-judgment interest at 18%, and attorney fees and collection fees for the collection of any amounts due on this Agreement. Any court judgment shall bear post-judgment interest at the highest rate allowed by law.
11) Everything that I have stated in the Agreement is correct to the best of my knowledge.
By signing this Agreement, I certify that I have read and fully understand my obligations and have been informed and understand the terms and conditions.