ACH Authorization Form

ACH Authorization Form
By signing this form, I acknowledge that I have accepted a financing offer from a third-party lender and authorize Kreative Gardens, LLC to withdraw the funded amount from my bank account.
I, First Name Last Name acknowledge that I have accepted such financing offer, and authorize Kreative Gardens, LLC to withraw the sum of $ Dollar Amount on the following basis
ONE-TIME withrawal within 1-2 business days after funding.
BILLING INFORMATION
Street Address* City* State* Zip*
Area Code* Phone Number*
Email
example@example.com
BANKING INFORMATION

BANK (ACH)
Bank Name: Bank Name*
Account Type:*

CheckingSavingsOther
Name on Account: First Name* Last Name*
Routing Number: Number Account Number: Number*
Late Fee: A late fee of $25 of the outstanding amount will be charged if payment is not received within 10 days.

Returned ACH Fee: I understand that if my ACH payment is returned due to insufficient funds, a processing fee of up to $25 may be charged by Kreative Gardens in addition to any fees assessed by my financial institution.

Cancellation & Refund Policy: I understand that I may cancel this payment authorization and request a refund only if Kreative Gardens has not begun work on my project.

Once installation or site preparation has started, all payments become non-refundable, and cancellation is no longer available, except as required by law.

Any request for cancellation must be submitted in writing at least three (3) business days before the scheduled installation date.

Your information is collected solely for payment porocessing and will not be shared except as required by law.
I confirm that I am an authorized signer on the bank account provided above and hereby authorize Kreative Gardens, LLC to initiate a one-time ACH debit in accordance with the terms stated above.
Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

ACH Authorization Form

BILLING INFORMATION

BANKING INFORMATION