ACH Payment Authorization Form

This legacy page will soon be discontinued. For your convenience please start using our payment portal at portal.yourtrimmers.com

Thank you,

Mary Jane's Friends & Co. Team.

Account Type *

Account Number *

Routing Number *

Company Name *

As it appears on your account

Invoice # *

Check Number

Optional

Payment Amount *

Sign and complete this form to authorize The Cultivators, LLC dba. Mary Jane's Friends & Co. to make a one (1) time debit to your checking or savings account. By signing this form, you give us permission to debit your account for the amount indicated above. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as today. In the case of the payment being rejected for Non-Sufficient Funds (NSF) I understand that Mary Jane's Friends & Co. may, at its discretion, attempt to process the charge again within 24 hours, and I agree to an additional $45 charge for each attempt returned NSF, which will be initiated as a separate transaction from the authorized payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I will not dispute The Cultivators, LLC dba. Mary Jane's Friends & Co. billing with my bank so long as the transaction corresponds to the terms indicated in this agreement. Depending on your banking institution, we may convert this transaction to an electronic check *

I agree

Authorized Signature *

This legacy page will soon be discontinued. For your convenience please start using our payment portal at portal.yourtrimmers.com

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