Payment Consent Form- Auto Charge
**Auto Charge is a paperless/Email only system-Please keep an eye on your spam folder.
Cardholder's Full Name
*
First Name
Last Name
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail for payment receipt
example@example.com
Please read and sign the below form
(This form is valid for the time customer is on auto charge until Recycle Depot gets written notice from customer wanting to be removed from the auto charge system)
By signing this form, I authorize Recycle Depot, In accordance with the Sales Agreement we have made at the start of service, to deduct the balance owed from my credit card on a recurring bases as agreed at set up. By signing this form, I give Recycle Depot permission to automatically charge the card provided until containers are returned to Recycle Depot and balance is paid in full. By signing this form, I also acknowledge that the 3rd unsuccessful payment attempt will receive a $30 bank fee. By signing, I also acknowledge the fee schedule, as stated on my invoices and that my card will be charged a balance that may include late fees if my account is past due. I am required to update Recycle Depot upon the expiration date and/or other necessary changes as the credit card is renewed by my bank. At any time that I need to stop my autopay, I understand that I need to notify Recycle Depot, in writing, before the next billing cycle. **THIS IS VALID FOR THE ENTIRE TIME YOUR ACCOUNT IS ON AUTO CHARGE**
*
Please verify that you are human
*
Submit
Should be Empty: