ACH Autopay Enrollment — C&M Tech Solutions

Pay by Credit Card: Enter your info and service details. You'll be redirected to Bill.com's secure page to enter your credit card. A convenience fee applies to card payments.

Contact

Service

Customer Information

First Name *

Last Name *

Company Name

Email Address *

Phone Number

ACH Bank Account

Name on Account *

Routing Number *

9-digit number (bottom left of check)

Account Number *

Account Type *

Service & Billing

Service Description

Monthly Amount ($) *

First Due Date *

ACH Authorization

By enrolling, you (Customer) authorize C&M Tech Solutions LLC to initiate recurring ACH debit entries to the bank account provided. Debits will occur on the invoice due date for the amount of $0.00 per billing cycle.

This authorization will remain in effect until you notify C&M Tech Solutions in writing to cancel, allowing reasonable time to act on your request.

I authorize C&M Tech Solutions LLC to debit my bank account as described above. I confirm the account information provided is accurate and I have authority to authorize this transaction.

Customer—

Account Type—

Routing Number—

Account (last 4)—

Monthly Amount—

First Due Date—

✓

Enrollment Complete

ACH autopay has been set up successfully. A confirmation will be sent to your email.

Provider—

Customer ID—

Invoice / Subscription—

Status✓ Autopay Active