Authorization for Direct Payments via ACH/Credit Card
I, as a duly authorized representative of the Client, authorize Mind-Storm, to electronically debit the below account and/or process credit card in the amounts and at the times set forth in executed Statement of Work, and, if necessary, to electronically credit that account to correct erroneous debits.
Client information:
Bank information:
Credit Card Number:
It is acknowledged that this authorization will remain in full force and effect for the duration of the Term or until revoked by the Client in a writing delivered in accord with the Agreement.
Signature below
Street address: