Secure Recurring ACH Payment Authorization for Auto-Pay

Secure Recurring ACH Payment Authorization for Auto-Pay
Name*
Address*
City*
State*
ZIP*
Email*
example@example.com
Phone*
Bank Name*
Chase, Bank of America, ...
Account type:*

CheckingSavings
Routing Number*
Account Number*
Authorization Details: I hereby authorize New Racquet Sports LLC (DBA Net Racquet Club) to initiate automatic recurring payments from my bank account on a monthly basis for the purpose of paying my membership fees. I understand that the payments will be automatically deducted from my bank account on the first day of each month.

Payment Frequency: Monthly

I understand that I may cancel this authorization at any time by notifying Net Racquet Club in writing or by contacting manager@netracquetclub.com. I also understand that I am responsible for any charges or fees that may be incurred if there are insufficient funds in my account or if the payment is declined for any reason.

Please Note: This authorization will remain in effect until Net Racquet Club receives written notification from
First Payment Date*

MonthDayYear
First day of the month
Member's signature*

Clear
Date*

MonthDayYear
Date
Bank account holder's signature (if different)

Clear
Date

MonthDayYear
Date
For any questions or further assistance, please feel free to contact us.

Net Racquet Club 4545 Spring Valley Rd. Farmers Branch, TX 75244
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