ACH Authorization for Variable Withdraws

You authorize regularly scheduled charges to your Bank Account. A receipt for each payment will be provided to you and the charge will appear on your Bank Account Statement. You will receive an invoice 5 days prior to your Bank Account being charged. You agree that if you do not dispute the invoice within 5 days that the invoice/charges are valid.

I authorize AltrueTECH LLC to electronically debit my bank account according to the terms outlined below. I acknowledge that electronic debits against my account must comply with United States law..

Billing Details:

Bank (ACH) Information:



I understand that this authorization will remain in effect until I cancel in writing, and I agree to notify the merchant in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments 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debits to my checking/savings account, I understand that because these are electronic transactions, these funds maybe withdrawn from my account as soon as the above noted periodic transaction dates. In the case of ACH transaction being rejected for Non-Sufficient Funds (NSF) I understand that the merchant may at its discretion attempt to process the charge again within 30 days, and agree to an additional $35 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 transaction to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account and will not dispute these scheduled transactions with my bank; so long as the transaction correspond to the terms indicated in this authorization.


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Signed by David Sherrill
Signed On: June 7, 2024

Signature Certificate
Document name: ACH Authorization for Variable Withdraws
lock iconUnique Document ID: 57c6c34ca2fd3901800e7b8b07ba1ad50cc47c37
Timestamp Audit
January 27, 2022 12:41 pm EDTACH Authorization for Variable Withdraws Uploaded by David Sherrill - IP