ACH Authorization Form
JK Products & Services, Inc.
Customer Information
Customer Name:
*
First Name
Last Name
Customer Number:
*
Please ask your JK Sales Specialist for assistance if needed.
Business Name
*
Customer Email:
*
example@example.com
JK Products Sales Specialist:
*
I understand that I'm authorizing all JK Light and Parts orders to be automatically ACH drafted from my bank account. To opt out please select:
I don't want automatic ACH payments for JK Light (Lamps, Lotions, Accessories)
I don't want automatic ACH payments for Parts
Bank Account Information
Name on Account:
*
Routing Number:
*
Bank Account Number:
*
Bank Name:
*
Bank Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
*
-
Month
-
Day
Year
Date
By checking this box, I acknowledge that all information provided is correct and I will notify JK Products & Services should my bank information change. Once the ACH form is submitted Accounting will update your payment terms. The ACH terms will be valid until you email AR@JKAmerica.com and change them back to credit card terms. Once an order is shipped and invoiced your bank account will be drafted the next business day. You will receive an ACH Draft Pre-Notification to the provided email. A $30 fee will be assessed for each returned ACH. If ACH payments are returned twice, Credit card payments will be required.
*
I acknowledge
For any questions please reach out to Accounting at
AR@JKAmerica.com
.
Submit
Should be Empty: