ProToCall Payment Authorization Form

Business Information

Fill out the information below to setup payent authorization. Choose between Credit Card payments or ACH payments.

Company Name

Company Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Tax ID Number (EIN) *

Accounting Contact

Accounting Contact Name *

Accounting Contact Phone *

Accounting Contact Email *

ACH Payment Authorization

Choose this option if you would like to pay your invoices through ACH payments.

I authorize ProToCall, LLC to debit the Checking/Savings account above for the total amount of invoice(s) resulting from Work Orders and Quotes placed and approved by employees of above company.
By signing below I certify that I am an authorized user of this bank account and will not dispute these charges with my bank so long as the transactions correspond to the terms indicated in this authorization.

Bank Name

Account Type

Checking Account
Savings Account

Bank Account Number

Bank Routing Number

Bank Address

Address Line 1

Address Line 2

City

State

Zip Code

Bank Phone

Credit Card Payment Authorization

If you would like to pay your invoices with a credit card, please fill out the information below.

I authorize ProToCall, LLC to charge the credit card above for the total amount of invoice(s) plus applicable fees of 3% resulting from Work Orders and Quotes placed and approved by employees of above company.

By signing below I certify that I am an authorized user of the credit card account and will not dispute these charges with my bank so long as the transactions correspond to the terms indicated in this authorization.

Cardholder Name

Card Number

Card Expiration Date

Card CVV Number

Billing Zip Code

Company Representative

The name of the person filling out the form.

Name *

First

Last

Title

Date / Time

Date

Time

Signature *

Business Information

Accounting Contact

ACH Payment Authorization

Credit Card Payment Authorization

Company Representative

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