Authorization for Credit Card/ACH Payment USE


Please complete and digitally sign this form to authorize the merchant(s) below to debit your account for the amount indicated on or after the indicated date.

Terms and Conditions

I understand that this authorization will remain in effect until I cancel it in writing, I agree to notify the merchant in writing 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. In the case of a transaction being rejected or returned (NFS) I understand that the merchant may at its discretion attempt to process the charge again, and agree to an additional $75 charge for any returned payments. I certify that I am an authorized user of this credit card/bank account and will not dispute these schedule transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization from.

Please upload a photo of the front of your drivers license

By Typing your name you authorize Ride and Drive 1-6 to charge my credit card or bank account for the amount of.

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