Purchase Agreement

Purchase Agreement
Merchant DBA
Address
Phone
Terminal Type
Quantity Price each
Total excluding sales tax
All accounts will be charged $____ monthly fee per terminal.
I, the undersigned, agree and understand that I will be billed via electronic ACH for this purchase. I authorize the ACH to be processed from the bank account I have on file with PCBancard.
Signature of Authorized Signor

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Date

MonthDayYear
Date
Printed Name of Authorized Signor
Sim Cards for Wireless Terminals (optional)

Monthly Fees based on Data Allowance
Choose Plan:

1 MB $7.5010 MB $16.50100 MB $29.951 GB $44.95
I, the undersigned, agree and understand that I will be billed via electronic ACH for this purchase. I authorize the ACH to be processed from the bank account I have on file with PCBancard.
Date

MonthDayYear
Date
Printed Name of Authorized Signor
Signature of Authorized Signor

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PCBancard Representative Email
example@example.com
Should be Empty: