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Enter Case Number – Returnsystem2023-01-30T12:52:37-05:00

AR CARD AUTHORIZED & SIGNED DEBIT AGREEMENT(2)

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Street Address
Legal Authorization To Debit Account*

TERMS & CONDITIONS

I hereby authorize debit(s) to the above account, on the dates listed above. I certify that I am an authorized user of this account. I make this agreement willingly and understand that any attempt to file a dispute or chargeback for any of the charges covered under this agreement will initiate an immediate banking security audit.

I CONSENT TO ALL CALLS AND TEXT MESSAGES RELATED TO THIS MATTER

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