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AMS Services Inc. | Fax to: 303.222.6435 | Accounting
As a convenience to our AMS Services, Inc. customers, we offer electronic funds transfer and automatic credit card processing for your monthly support fees. This payment option allows our customers to automatically and effortlessly remain current on support fees. Terms of the EFT are below. In order for your payments to be withdrawn through EFT or automatic credit card please fill in the necessary information listed below and fax to 303.222.6435.
By completing the information below you agree to
authorize AMS Services, Inc. to withdraw your monthly support fees from
your credit card or through Electronic Funds Transfer.
Selecting EFT qualifies you for a 1% discount off all support fees,
excluding hardware maintenance fees
(for non-online customers only).
| AMS Billing Customer #: | |||
| Agency Name: | |||
| Agency Phone #: | |||
| Agency Addr (City, State, Zip): | |||
| |||
Automatic Credit Card Processing (not subject to 1% discount):
| Credit Card Type: | |
| Credit Card #: | |
| Expiration Date: | |
| Account Holder Name: | |
| *Account Holder Signature: | ___________________________________________________ |
Authorization Agreement For Pre-Arranged Payments through Electronic Funds Transfer (subject to 1% discount):
I (we) hereby authorize and request AMS, hereinafter called Company, to effect payment in the amount of our monthly support fees, plus any applicable taxes, per month or for any amount owing by me (either of us) as such amounts become due by initiating debt entries to my (our) checking account indicated below in the bank named below, hereinafter called Bank. I (we) authorize and request Bank to accept any debt entries by Company to such account and to debit the same to such account without responsibility for the correctness thereof.
| Name of Bank: | |
| Routing Number: | |
| Account Number: |
It is understood that this agreement may be terminated by me (either of us) upon thirty (30) days written notification to Company or Bank. Any such notification to company shall be effective only with respect to entries initiated by Company after receipt of such notification and a reasonable opportunity to act upon it. Any such notification to Bank shall be effective only with respect to entries debited to my (our) checking account by Bank after receipt of such notification and a reasonable time to act upon it.
| *Authorized Signature: | ___________________________________________________ |
| Date: | __________________ |
Print & fax the form, including signature(s) to 303.222.6435.
AMS Services, 2477 55th St, Boulder CO 80301
Electronic Funds Transfer Agreement
It is understood that all debit entries initiated by Company pursuant to this agreement shall be subject to the following provisions:
(1) If the amount of an entry to be initiated by Company differs from that of the next previous entry initiated pursuant to this agreement, company shall; within not less than thirty (30) calendar days before such succeeding entry is to be debited to Customer’s checking account, send to Customer written notification of the amount of such entry. Similarly, if any change is made by Company in the date of the billing cycle; on or after which such entries are to be debited to such checking account, company shall, within not less than thirty (30) calendar days before the first entry to be affected by such change is to be debited to such checking account. The provision will not apply if the Customer has authorized the initiation of a single entry to his checking account or if the Customer has agreed that entries representing indebtedness to his checking account may be debited at any time after the indebtedness is incurred.
(2) Customer may, by notice to Bank, stop payment of any entry initiated or to be initiated by Company to Customer’s checking account pursuant to this agreement but such notice must be received by Bank in such time and in such manner as to afford Bank a reasonable time to act on it. An oral notice shall be binding upon Bank only for fourteen (14) calendar days unless confirmed in writing within that period.
(3) If an entry is erroneously initiated by Company to Customer’s checking account, customer shall have the right to have the amount of such entry credited to such checking account by Bank; if within fifteen (15) calendar days following the date on which Bank sent or made available to Customer a statement of account or notifications pertaining to such entry. Customer shall send or deliver to Bank a written notice identifying such entry, stating that such entry was in error, and requesting Bank to credit the amount thereof to such checking account.
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