Please fill out this form to pay your contract via checking or savings account. You will be emailed statements. Company Name * Billing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Bank Details * Checking Account Savings Account Bank Name * Account Number * Routing Number * I hereby authorize Serving Those Serving to automatically charge the account listed above for the contract amount for EAP Services on the due date of each billing cycle. * Agree Electronic Signature * First Name Last Name Thank you!
