Payment Details Payment Method* Credit Card Bank Draft Bank Transfer Authorization Form* I authorize INT Dispatch 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.Payments based on weekly invoice amounts in which customer will be emailed every Friday. Bank Transfer Authorization Form* I authorize INT Dispatch to electronically charge my credit card.I, hereinafter called CARRIER do hereby authorize INT Dispatch, hereinafter called DISPATCH, to initiate a weekly debit entry for the amount listed below, on the dates listed below, to the credit card account indicated below, in consideration of the dispatching service provided to me. I understand that my signature on this authorization form, along with a photocopy of the front and the back of both my credit card, as well as my driver's license, will allow me the convenience of not having to produce these items for impression at the time of service.Business Name* Account Number* Routing Number* Account Type*Business CheckingPersonal CheckingSavingsCard Type*VisaMastercardAmerican ExpressDiscoveryCard Number*Name on Card* First Last Expiry Date* Zip Code* Security Code* This payment authorization is to remain in effect until notification of its cancellation by giving written notice in enough time for the business and receiving financial institution to have a reasonable opportunity to act on it. The written notice must be sent by email to info@intdispatch.com and by the original signing authorizer named.Signature*Printed Name* First Email* Phone*CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
