Customer / Company Name*

Invoice / Reference Number*

Payment Amount (USD)*

Credit and Debit Card payments will be subject to a 3% processing Fee (3.5% for Amex). ACH and E-Check are processed at no charge.

Payment Authorization I authorize Freemansburg Borough - Sewer to charge my payment method provided above for all agreed upon purchases. I understand that my information will be saved on file for future transactions on my account.

I have read and agree to the payment authorization terms above.*

Submit

Customer / Company Name*

Invoice / Reference Number*

Payment Amount (USD)*

Credit and Debit Card payments will be subject to a 3% processing Fee (3.5% for Amex). ACH and E-Check are processed at no charge.

Payment Authorization I/we authorize Freemansburg Borough - Sewer to debit the provided account for payments of all invoices issued by Freemansburg Borough - Sewer when they become due. Notification I agree to wave any regulatory requirements for pre-notification of debits Recourse You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement. To obtain more information about your recourse rights, you can visit www.https://www.nacha.org/ . Cancellation This authority is to remain in effect until Freemansburg Borough - Sewer has received written notification from you of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled in writing by email to null. You may obtain a sample cancellation form, or more information on your right to cancel a PAD agreement at your financial institution or by visiting www.nacha.org .

I have read and agree to the payment authorization terms above.*

Submit