ACH Recurring Payment Authorization Form

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Transformational Health Centers in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date. If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed that day or the following business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In case of an AHC transaction being rejected for Non Sufficient Funds (NSF) I understand that Transformational Health Centers may at its discretion attempt to process the charge again within 24 hours, and agree to an addition $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 transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.