Credit Card / Debit Card / ACH Payment Authorization
Full Name: Primary Tenant
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First Name
Last Name
Full Name: Secondary Tenant
First Name
Last Name
You authorize regularly scheduled charges to your credit card, debit card or bank account. You will be charged the amount indicated below each billing period. A receipt for each payment will be provided to you and the charge will appear on your credit card, debit card or bank statement. You agree that no prior-notification will be provided unless there is a charge collected for something outside the description provided, in which case you will receive notice from us at least 10 days prior to the payment being collected.
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I Agree
Your signature below authorizes Panthera Estates, Johnathan Pasch, any representative, or agent acting on behalf to charge your credit card, debit card, and bank account for the amount indicated as rent in the accompanying lease that works in conjunction with this authorizing document.
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I Agree
In addition to recurring payments you also authorize Panthera Estates, Johnathan Pasch, any representative, or agent acting on behalf to charge your credit card, debit card, and bank account for a one-time cost of up to $2000 for any costs incurred from: overdue Rent / late fees / all costs associated with eviction proceedings and restoration of Unit / Agent's or Owner's time processing eviction
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I Agree
Billing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the merchant in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that the merchant may at its discretion attempt to process the charge again within 30 days, and agree to an additional $_35_ charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form and the accompanying lease.
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I Agree
Primary Tenant Signature
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Secondary Tenant Signature
Date Time
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Submit
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