You can open the Auto Payment Agreement Template in multiple formats, including PDF, Word, and Google Docs.
Auto Payment Agreement Template Printable | Editable FormSample
[Name of the Company]
[Company’s ID]
[Company’s Address]
[Company’s Phone]
[Company’s Email]
[Name of the Client]
[Client’s ID]
[Client’s Address]
This document outlines the agreement for an automatic payment arrangement established on [Contract Start Date] for services rendered by the Company to the Client.
The purpose of this agreement is to authorize recurring payments from the Client’s designated account for [Specify services or purposes].
The Client agrees to pay the Company an amount of [Amount], which will be deducted automatically on a [Specify frequency, e.g., monthly, quarterly] basis.
Payments will be withdrawn from the following account: [Name of the Bank]
[Account Number]
[Type of Account].
The Client authorizes the Company to initiate the automatic debit transactions from the designated bank account for the duration of this agreement.
This agreement may be terminated by either party with a written notice of [Specify notice period] prior to the next scheduled payment date.
Any modifications to payment amounts or terms must be agreed upon in writing by both parties.
The Company shall not be liable for any overdraft fees or penalties incurred by the Client as a result of automatic debit transactions.
[Signature of the Company Representative]
[Name of the Company Representative]
[Signature of the Client]
[Name of the Client]
[Name of the Service Provider]
[Service Provider’s ID]
[Service Provider’s Address]
[Service Provider’s Phone]
[Service Provider’s Email]
[Name of the Client]
[Client’s ID]
[Client’s Address]
This agreement details the terms under which automatic payments will be set up starting from [Contract Start Date], relating to the services offered by the Service Provider to the Client.
The automatic payments cover the following services: [List specific services].
The Client agrees to a monthly payment of [Amount] to be automatically debited on the [Specify day] of each month.
The Client may cancel the automatic payment agreement by providing a written notice to the Service Provider [Specify notice period] in advance.
The Client must notify the Service Provider in writing of any changes to the payment method or account information at least [Specify notice period] prior to the next scheduled payment.
This agreement shall be governed by the laws of [Jurisdiction].
Both parties acknowledge that they have read, understood, and agree to the terms outlined in this Auto Payment Agreement.
[Signature of the Service Provider Representative]
[Name of the Service Provider Representative]
[Signature of the Client]
[Name of the Client]
Form
Please fill out the form below to create the Auto Payment Agreement Template. All fields must be completed to ensure a clear understanding of the auto payment terms. We provide examples to assist you with each step. Auto Payment Agreement Template 1. Customer Information 2. Auto Payment Details 3. Payment Method 4. Agreement Terms 5. Fees and Charges 6. Cancellation Policy 7. Confidentiality Clause 8. Acceptance and Signatures 9. Declaration
PDF
WORD
Auto Payment Agreement Template Printable | Editable FormPrintable
