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ACH

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Venue Info
Venue Name*
Venue Legal Name / DBA*
Venue Address*

Street Address

Street Address Line 2

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Postal / Zip Code
Venue Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Venue Website Address
Owner's Info
Contact Name*
Owner's Phone Number
Format: (000) 000-0000.
Owner's Mobile Number*
Format: (000) 000-0000.
Owner's Email*
Banking Info
Venue Employer Identification Number (EIN)*
Bank Name*
Enter Routing Number*
Account Number*
Authorize
I authorize my bank to debit my account as identified above to the terms stated here. This authorization shall remain in effect CityCheers and bank receive written notification from me of intent to terminate at such time and in such a manner as to afford CityCheers and bank reasonable opportunity to act (Minimum 30 days). All other changes such as payment amount, frequency, bank account number change, will require a new ACH Debit Payment Authorization Form to be filled out and submitted to CityCheers 15 days prior to any change being implemented. I understand that this payment plan may be cancelled by CityCheers due to NSF (Non-sufficient Fund). I will be liable to pay an NSF fee of $35.00 (or the amount allowable by law), which may be automatically debited for each NSF.
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ACH

Venue Info

Owner's Info

Banking Info

Authorize