Freight Girlz_Bank Transfer Authorization Form

Bank Transfer Authorization Form

I authorize JTAC Services Inc. dba Freight Girlz to electronically debit my bank account according to the terms outlined below. I acknowledge that electronic debits against my account must comply with United States law.

Terms of billing *

Starting onfor the amount of $ (SEE BELOW) and accordingly thereafter per the terms in invoice(s) Payments based on weekly invoice amounts in which customer will be emailed every Friday.

Customer bank account information:

Business Name *

Account number *

Routing number *

Account type *

Personal Checking Business Checking Savings

This payment authorization is to remain in effect until I,

, notify 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. The written notice must be sent by email to support@freightgirlz.com and by the original signing authorizer named

Customer signature *

Clear

Customer printed name *

Date

Customer Email *

example@example.com

Phone Number *

Please enter a valid phone number.

Please verify that you are human *

JTAC Services Inc. dba Freight Girlz 6262 North Swan Road, Suite 200 Tucson, AZ 85718 (737)400-5623