PAYMENT AUTHORIZATION FORM

I authorize Unlimited Roofing to (A) electronically debit my bank account or (B) charge my credit card in accordance with the terms outlined below. I acknowledge that the electronic debits to my bank account must comply with the United States' law. I acknowledge that there will be an additional transaction fee if I choose to pay by credit or debit card.

This payment authorization is to remain in effect until I,

, notify Unlimited Roofing of its cancellation by giving written notice in enough time for the business and receiving financial institution to have a reasonable opportunity to act on it.

TERMS OF BILLING:

DOWN PAYMENT / DEPOSIT: One-time Payment

FINAL PAYMENT: One-time Payment to be run within 48 hours of your project completion.

Final Payment *

$

PICK ONE FORM OF PAYMENT

(A) ACH: CUSTOMER BANK ACCOUNT INFORMATION - NO TRANSACTION FEE

Routing Number

(B) CREDIT/DEBIT CARD - 2.999% TRANSACTION FEE

Billing Phone Number

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