I authorize First Look Approval to debit my account for the one time enrollment fee to the terms stated here. This authorization shall remain in effect until First Look Approval receives a 30-day written notification from me of intent to terminate in such manner as to afford First Look Approval and the bank reasonable opportunity to act (minimum 30 days).
I understand that if the total amount owed to First Look Approval is increased, I authorize this plan to continue as long as the payment amount remains unchanged until the amount owed First Look Approval is paid off, or unless the plan is terminated earlier by me as above. I understand any added amounts can be applied for with a new Payment Authorization Form.
All other changes such as payment amount, frequency, and bank account number change will require a new Payment Authorization Form to be filled out and submitted to First Look Approval 15 days prior to any change being implemented. I understand that this payment plan may be cancelled by First Look Approval due to non-sufficient funds (NSF). In the event my account does not have sufficient funds for the payment, I will be liable to pay an NSF (non-sufficient funds) fee of $25.00 per occurrence (or the amount allowable by law), which may be automatically debited for each NSF.
I represent and warrant that I am authorized to execute this payment authorization for the purpose of implementing this one time enrollment fee. I indemnify and hold the service provider, the bank and First Look Approval harmless from damage, loss or claim resulting from all authorized actions hereunder.
Revised May 1, 2014
I understand that if the total amount owed to First Look Approval is increased, I authorize this plan to continue as long as the payment amount remains unchanged until the amount owed First Look Approval is paid off, or unless the plan is terminated earlier by me as above. I understand any added amounts can be applied for with a new Payment Authorization Form.
All other changes such as payment amount, frequency, and bank account number change will require a new Payment Authorization Form to be filled out and submitted to First Look Approval 15 days prior to any change being implemented. I understand that this payment plan may be cancelled by First Look Approval due to non-sufficient funds (NSF). In the event my account does not have sufficient funds for the payment, I will be liable to pay an NSF (non-sufficient funds) fee of $25.00 per occurrence (or the amount allowable by law), which may be automatically debited for each NSF.
I represent and warrant that I am authorized to execute this payment authorization for the purpose of implementing this one time enrollment fee. I indemnify and hold the service provider, the bank and First Look Approval harmless from damage, loss or claim resulting from all authorized actions hereunder.
Revised May 1, 2014
