EmailMe Form - NTM - ACH Authorization Form

If you would like to enjoy the convenience of automatic billing, simply complete the ACH Banking Information section below and sign the form. All requested information is required. Upon approval, we will automatically draft from your bank information provided the amount indicated and your total charges will appear on your monthly bank statement. You may cancel this automatic ACH billing
authorization at any time by contacting us.

Customer Name: *

Business Name: *

Phone *

### - ### - ####

I authorize Nick the Marketer, LLC to automatically bill the bank account listed below as specified:

Amount (Ad Spend only) *

$ Dollars

PLEASE NOTE: Ad spend payments will be charged directly from Google and/or Facebook and/or TikTok. Ad spend budget can be modified per customer request at any time w/out new credit card authorization form completed. Credit card processing surcharge will NOT be added to ad spend payments as they are processed directly through Google/Facebook/TikTok.

Frequency *

Start Billing On: *

MM / DD / YYYY

End Billing When: *

Bank Account Type *

Business Checking

Savings

Name of Bank *

Routing Number *

Checking Account Number *

Image

Signature

Clear

Today's Date *

MM / DD / YYYY