Official Authorization Document

ACH Direct Debit Authorization

Complete this form to authorize VoicePlug Inc. to initiate automatic ACH debit transactions from your bank account for payment of outstanding invoices.

Section 1

Business / Customer Information

Tell us who is authorizing this debit.

Legal business name

Contact name

Contact email

Contact phone

Billing address

Section 2

Bank Account Information

This is the account we'll debit for outstanding invoices.

Name on bank account

Bank name

Bank city / state

Account type

Routing number

9-digit ABA number on the bottom-left of your check.

Account number

Address on bank account (if different from billing address)

Section 3

Authorization Terms

Please read carefully before signing.

I authorize VoicePlug Inc. to electronically debit the bank account listed above for the amount of outstanding invoices issued to me, on a recurring or as-invoiced basis, until I revoke this authorization in writing. I understand that I may revoke this authorization at any time by contacting VoicePlug Inc. with reasonable advance notice to allow VoicePlug Inc. to act on the cancellation. I certify that I am an authorized signer on the bank account listed above and have the authority to grant this authorization.

I have read and agree to the authorization terms above.

Electronic signature (typed full name)

Typing your name acts as your legally binding signature.

Date

By submitting, you authorize the ACH debit described above.

Your information is transmitted securely and stored with strict access controls. Only authorized VoicePlug personnel can view submitted authorizations.