ACH Authorization for Direct Payment

Authorization

I (we) authorize Elevate Group LLC dba AIM (Affordable Intelligent Marketing) (“COMPANY”) to electronically debit my (our) account (and, if necessary, electronically credit my (our) account to correct erroneous debits) as follows:

Confirm *

Authorization

I (we) authorize Elevate Group LLC dba AIM (Affordable Intelligent Marketing) (“COMPANY”) to electronically debit my (our) account (and, if necessary, electronically credit my (our) account to correct erroneous debits) as follows:

Payment Frequency and Date

All funds are drawn on the first of each month. Any bank holidays or delays may result in it occurring on the next business day.

Payment Contact Details

First Name *

Last Name *

Territory and Brand *

PLEASE NOTE that if you have multiple entities and want billing to multiple accounts, you will enter each below. List both names here. If the contact information for them is different, it might be better to complete this form twice for each one. Ideally, label one Entity 1, and the other Entity 2 for clarity below.

Email *

Address *

City *

State *

Postal code *

Payment Information - Entity 1

Brand, Name, and Number of Entity 1 *

Max Monthly Authorized (Payment) Amount - Entity 1

If you know your monthly charges, enter it here. If you do not - reach out to us or fill in a maximum amount.

Authorization - Entity 1

Please fill out the following account details fields.

Depository (Financial Institution) Name - Entity 1 *

Routing No. - Entity 1 *

Account No. - Entity 1 *

Account Type - Entity 1 *

Checking

Savings

Account Type II - Entity 1 *

Business

Personal

Payment Information - Entity 2

You only need to fill this in IF you wish to have billing to separate accounts for different entities.

Brand, Name, and Number of Entity 2

Max Monthly Authorized (Payment) Amount - Entity 2

If you know your monthly charges, enter it here. If you do not - reach out to us or fill in a maximum amount.

Authorization - Entity 2

Please fill out the following account details fields.

Depository (Financial Institution) Name - Entity 2

Routing No. - Entity 2

Accounting No. - Entity 2

Account Type - Entity 2

Checking

Savings

Account Type II - Entity 2

Business

Personal

Authorization - Entity 2

I (we) understand that this authorization will remain in full force and effect until I (we) notify COMPANY in writing that I (we) wish to revoke or amend this authorization. I (we) understand that COMPANY requires at least [30 days] prior notice in order to cancel this authorization.

Signature *

Clear

Date *

Clicking Submit will complete the form.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.