BoiseWiFi-Logos-07-2017

 

2811 S Pond St, Boise ID 83705 / 208-571-4741 office / 888-344-4644 fax / 208-473-1662 support / BoiseWiFi.net /  admin@boisewifi.net

 

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Recurring Payment Authorization Form

Scheduled monthly payments will be automatically charged to the credit / debit card below.

 

Here’s How Recurring Payments Work:

You authorize regularly scheduled charges to the credit / debit card form below.  You will be charged the amount indicated below each billing period.  A receipt for each payment can be emailed to you and the charge will appear on your bank statement.  You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

 

 

Please complete the information below:   

(PLEASE NOTE: This is not an online form. Simply fill it out, print the page, scan and email or fax it to us.)

 

I  authorize BoiseWiFi / Ryals Communication to charge my credit/debit                           

     (full name as it appears on the card)

card indicated below for $  on the of each month{C}{C} as payment for Internet Service.  

                                            ($$ amount)             (1st or 15th)                                                        

Billing Address   Phone#

City, State, Zip   Email    

                     Credit / Debit Card Info

 

Cardholder Name
Card Number
Exp. Date (mm/yy)
CCV (code#)
 

 

SIGNATURE:   DATE

 

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify BoiseWiFi in writing by email 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debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that BoiseWiFi may at its discretion attempt to process the charge again within 30 days, and agree to an additional $25 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 transactions to my account must comply with the provisions of U.S. law.  I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form. Email = admin@boisewifi.net