ACH TRANSACTION AUTHORIZATION AGREEMENT

I (we) authorize Digital Web Group Inc. to electronically debit my (our) account (and, if necessary, electronically credit my (our) account to correct erroneous debits) to my CHECKING or SAVINGS account (Check One) at the financial institution (Bank) named below.

Select One*

One Time Payment
Renewal
New
Terminate

Name*

First Last

Billing Address*

Address Line 1 Address Line 2 City State ZIP Code

Phone Number*

Account Type*

CHECKING
SAVINGS

Name on Check*

Name of Bank*

Other Bank Name

Check Number*

Account Number*

Reconfirm Account Number

9 digit Routing*

Photo of the Check

Max. file size: 2 MB.

Amount*

Services

Authorization*

By signing below, I acknowledge that I have read, understood, and accepted the terms of this declaration. I authorize the electronic transfer of funds as described above.

Signature*

Upoload your Signature
Digital Signature

Signature*

or

Upload Your Signature

Max. file size: 2 MB.

Declaration*

I hereby certify that the bank account information provided above is true and accurate. I declare that I am an authorized signer or the sole owner of the account listed above and have the full legal authority to authorize these transactions.