I hereby authorize this company to debit my bank account through the electronic Automated Clearing House (ACH) network within one to three business days from the date of this payment. I am aware that in the event this company is unable to secure funds from my bank account for this transaction for any reason, including but not limited to, insufficient funds in my account or insufficient or inaccurate information I provided when I submitted the electronic payment, further collection action may be undertaken by this company, including application of returned check fees to the extent permitted by law. If the payment is returned by my bank, I am still responsible for making a payment to this company.
15 Valley Drive
Thiells, NY 10984