Bryan Pest Control | Credit Debit-Auto Pay Form

Sign Up for e-Check (ACH) Auto-Pay

Auto-Pay is a safe and easy way to pay your bills online.

By signing up for Auto-Pay you are agreeing that all payments will be made in full on the first business day of the month after service has been completed.

We can email a copy of the Auto-Pay Authoriziation form to you and return it to any of our local offices, or you can fill out the online form below.

If you are a current Auto-Pay customer and your payment information has changed (new credit card, etc), please contact angela@bryanpestcontrol.com or call (850) 862-3955 to update your information (this information cannot be updated online).

e-Check (ACH) Auto-Pay

Customer Billing Information

First Name

Last Name

Service/Property Address

Billing Address (if different from above)

City

State

Zip Code

Primary Phone

Alternate Phone

Your Account #

Recuring payment?

Yes

Check all that apply:

Annual Termite

Quarterly Pest

Monthly Lawn

Mosquito

e-Check (ACH Debit) Information

Name on Account

Financial Institution

9-Digit Bank Routing Number

Account Number

Branch Location

AUTHORIZATION AGREEMENT FOR ACH PAYMENTS
I (we) do hereby authorize Bryan Pest Control, hereinafter named the COMPANY, to initiate debit entries to my (our):

Select an option

Checking Account

Savings Account

indicated and named above as the depository financial institution, hereafter named FINANCIAL INSTITUTION, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. Furthermore, if any such debit(s) should be returned NSF, I authorize the COMPANY to collect such debit(s) by electronic debit and subsequently collect a returned debit NSF fee of $25.00 per item by electronic debit from my account identified below. I am a duly authorized check signer on the financial institution account identified below, and authorize all of the above as evidenced by my signature below.

Your Signature

Date

This authorization is to remain in full force and effect until the COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford the COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it.