Recurring Payment Authorization Recurring Payment Authorization FormYou 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.IFull Name authorize Salt Lake City Table Tennis to charge/debit my account indicated below each month for payment of my club membership.Billing Address PhoneCity, State, Zip Email Checking /Savings AccountHiddenChecking Or Savings Checking Savings HiddenName on Account HiddenBank Name HiddenAccount Number HiddenBank Routing #HiddenBank City/State Credit CardHiddenCredit Card Visa Amex Mastercard Discover HiddenCardholder Name HiddenAccount NumberHiddenExpiration Date HiddenCVV (3 digit no. on back of the cardSignatureDate MM slash DD slash YYYY I understand that this authorization will remain in effect until I cancel by email to tabletennisutah@gmail.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debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above stated periodic transaction dates.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 form.