ED4 Budget Payment Plan Recurring Credit Card Authorization Form

ED4 Budget Payment Plan Recurring Credit Card Payment Authorization Form
CARD INFORMATION
- The card details can be obtained from your bank or credit card statement
- Ensure all required fields are completed accurately
SIGNATURE
- The Payment Authorization Form must be signed by the primary credit card holder for Credit Card
IMPORTANT INFORMATION
- If you wish to switch your payment information please contact the District Office or update on our payment portal
- Auto payments will be processed on the 10th of each month
If you have any questions, please contact the District Office at:

Phone: 520-466-7336

Email: payments@caidd.com

ED4 Budget Payment Plan Recurring Credit Card Payment Authorization Form
This authorization form will remain in effect until either canceled in writing, an updated form changing the information is submitted, provided update information over the phone, or updated information on payment portal.
Card Information
Financial Institution Name
Is the a Credit or Debit Card
Card Type
Name that Appears on the Card

First Name or BusinessLast Name
Card Number
Expiration Date
Customer Account Information
Book - Account Number
Name as it Appears on Utility Account

First Name or BusinessLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I hereby authorize ED4 to automatically withdraw from my Credit Card the total amount due on my billing statement and to make deposits if necessary for error correction. I authorize the Financial Institution named above to accept such transactions initiated by ED4. The withdrawal shall be made from my credit card on the 10th day of the month. I am aware of my right to stop a withdrawal by notifying ED4 at any time up to three (3) business days before the withdrawal date. If an erroneous withdrawal occurs and I notify the Financial Institution of the error within 60 days of the issuance of my account statement, the institution must investigate and resolve the error within 45 days of notification. If the error is not resolved within the first 10 business days following receipt of my notification, my account shall be re-credited for the amount in question until the investigation is completed. (Condensed for Regulation E, Electronic Fund Transfer Act for the consumer's protection. For more information, contact your Financial Institution.)
Signature
Signature Date

MonthDayYear
Date
Should be Empty:

ED4 Budget Payment Plan Recurring Credit Card Payment Authorization Form

CARD INFORMATION

SIGNATURE

IMPORTANT INFORMATION

ED4 Budget Payment Plan Recurring Credit Card Payment Authorization Form

Card Information

Customer Account Information