Authorization for Automatic Credit/Debit Card Payment
Last four of Social Security number
Type of Card
Street Address Line 2
District of Columbia
Agreement Terms and Conditions
By signing below, you authorize Sullivan Motors / Mid-Atlantic Auto Finance to process recurring debit entries from credit/debit card identified above in accordance with the payment schedule on your account. Your payment will be made automatically from your designated account. If your due date falls on a weekend or holiday, your payment will still be processed on the payment due date. If a charge has been initially declined, you authorize us to attempt to re-charge the card at a later date up to (3) three times. You may cancel this authorization by providing written notice or by completing a new copy of this form with a new card. Notice of cancellation must be received at least forty eight (48) hours prior to the payment due date or payoff of the contract. For inquiries about credit card transactions or your account with us, please call (609)861-0045.
Electronic Signature Agreement. By selecting this box, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting this box, you consent to be legally bound by this Agreement's terms and conditions.
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