
PLEASE READ THE FOLLOWING MANDATORY AUTHORIZATION.
By using any of the following forms of payment, I certify that I have read and understood the contents of this authorization; that all of the information submitted by me is accurate and current; that there are sufficient funds to cover the stated amount; that I have the authority to write checks and/or tender payment from said account; and that I intend it to have the same force and effects as if I personally tendered my payment to Alarm Works West, Inc. I authorize my financial institution listed on the payment form to accept any debit entries initiated by Alarm Works West, Inc. as genuine, and further authorizes said debits to be debited from the account. I further agree to pay a returned item fee of $30 per item for payments submitted to my financial institution that are returned to Alarm Works West, Inc. unpaid. Also, after the account has been charged, I have the right to have the amount of an erroneous debit immediately credited to my account by the financial institution up to 15 days following issuance of statement or 45 days after the account is charged, whichever occurs first.
If you do not wish to use our forms for submission, you may call our office
at 888-427-2527 [opt 3]
I
Do Not Agree
Pay by CHECK ![]()
Alarm Works West, Inc.
Copyright © 2002 All rights reserved.
Revised:
03/30/02 12:56.