CLIENT BILLING AUTHORIZATION FORM“*” indicates required fieldsIt is understood and acknowledged that all monthly service clients must have an automated form of payment on file at all times. To that end, we hereby request that “fuelAI Inc” (Company) use the following automatic form of payment to pay for any amounts owed to them. Company Name Your Name Email Mobile Phone Address Address line 2 City State Zip Pay with Bank Transfer Form By default clients pay all agency fees via bank transfer / EFT Account Type Business CheckingBusiness SavingsPersonal CheckingPersonal Savings Routing/ABA Number (9 digits) Account Number Confirm Account Number Account Holders Name Order Authorization & Acknowledgement I hereby agree to and authorize the use of the payment information provided for my/our account, and understand that all sales are final and payments rendered are final and strictly non-refundable. I acknowledge that I have read and accept all terms of the data services agreement, and marketing services agreement on this site as well as the privacy policy and terms of service. I allow fuelAI Inc. to charge my fees to my bank account on the specified dates. Submit
