Marketing Audit

Authorization for Direct Payment via ACH (ACH Debit)

CONSUMER AUTHORIZATION FOR DIRECT PAYMENT VIA ACH DEBITS

Direct Payment via ACH authorizes the transfer of funds from your checking/savings account for the purpose of making a payment against Advertising Services rendered.

YOU MUST INCLUDE A VOIDED CORPORATE CHECK WITH THIS AUTHORIZATION.

Last Name *

First Name *

Email *

Mobile Phone *

I agree to terms & conditions provided by ECOM Industries, LLC. By providing my phone number, I agree to receive text messages from the ecom industries. Furthermore by submitting this form you agree to the use of your data to help underwrite your company for ACH Payments.

Legal Business Name *

Business Start Date *

Business Phone *

Business Street Address *

Business City *

Business State *

Business Zipcode *

Amount of debit(s) or method of determining amount of debit(s) [or specify range of acceptable dollar amounts authorized]:

Authorized DEBIT Amount *

USD

Authorized Number of Withdrawls *

Employer ID Number (EIN) *

MCC Code - Industry Category *

Business Owner First Name *

Business Owner Last Name *

Business Owner Identification (Driver's License, Passport, or State ID) *

Business Owner ID

Business Banking Institution Name *

Bank Institution City *

Bank Institution State *

Bank Account Type *

Business Checking

Business Savings

Enter your business bank account information and tell us where to deposit the credit card payments you accept.

Business Account Routing Number *

Business Bank Account Number *

"VOIDED" Business Check *

Voided Check

Please upload a "VOIDED" business check. Must not be a temporary check - Make sure to write "VOID" across your check.