ACH AUTHORIZATION FORM
ONE-TIME PAYMENT AUTHORIZATION, By completing and signing this form, you authorize Wasatch Bath to charge your credit card for the amount indicated. This authorization is for a single transaction only and does not provide permission for any additional charges.
Cardholder information (as it appears on card)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
CARDHOLDER SIGNATURE
I authorize Wasatch Bath to charge my credit card according to the terms stated in this authorization form. This payment is for the goods/services described and for the amount indicated only. This authorization is valid for one (1) transaction only. I certify that I am an authorized user of this credit card and will not dispute the transaction, provided it corresponds with the terms outlined in this form.
Signature
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Should be Empty: