Justin Long LLC

Recurring ACH Payment Authorization Form

  • By signing this form electronically, you give Justin Long LLC permission to debit your account for the amount indicated on or after the indicated date. This is permission for the recurring amount and frequency listed above, and does not provide authorization for any additional unrelated debits or credits to your account. This authorization is to remain in full force and effect until Justin Long, LLC has received an acknowledged notification or written notice to the address listed above. You may cancel payment with a phone call or email notification, as well.


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