Charge Authorization EN

    Charge Authorization

    ---

    Customer’s Name:
    Account holder name:
    Account holder address:
    City: State: Zip Code:
    Account holder telephone:
    Email:
    Bank name:
    Account Number:
    Routing number:
    Type of account:

    Service description:

    Amount:

    This is to authorize AES Accounting & Consulting LLC to charge my bank account for the above charges and agree to abide by the policies of AES Accounting & Consulting LLC.

    There will be no refunds of any kind for these charges

    Date:

    I understand that by signing this form I give authorization to AES Accounting & Consulting LLC to charge my credit card for the above charges and agree to abide by the policies of AES Accounting & Consulting LLC.

    There will be no refunds of any kind for these charges. Please provide us with a fax copy of both the front and back of the credit card that you are authorizing us to use.

    ***Payments made by credit/debit card are subject to an additional 3,5% administrative fee

    Signature:

    Capa-2