Recurring Payment Authorization Form
You authorize monthly scheduled charges to your checking/savings account or credit card. You will be charged each billing period for the total amount due for that period. The charge will appear on your bank or credit card statement. You agree that no prior notification will be provided to you for each scheduled payment, unless there is a change to the amount being charged.
Please complete the below information.
authorize Salt Lake City Table Tennis to charge/debit my account indicated below
each month for payment of my club membership.Checking /Savings AccountCredit Card
I understand that this authorization will remain in effect until I cancel by email to email@example.com, and I agree to notify SLCTT in writing of any changes in
my account information or termination of this authorization at least 30 days prior to the next billing date. If the above noted payment date falls on a weekend or
holiday, I understand that the payment may be executed on the next business day. For Ach debits to my checking/savings account, I understand that because these
are electronic transactions, these funds may be withdrawn from my account as soon as the above stated periodic transaction dates. In the case of an Ach transaction
being rejected for Non-Sufficient Funds (NSF) I understand that SLCTT may at its discretion attempt to process the charge again within 30 days, and agree to an
additional $10 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the
origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and
will not dispute the scheduled transactions with my bank or credit card Company; provided the transactions correspond to the terms indicated in this authorization