|Processed by National Payment Card|
(to be used for merchant evaluation only)
Authorization: By checking this box and submitting this information, I confirm that I am at least 18 years old and have read and agree to the Enrollment Terms and Conditions. I authorize National Payment Card Association to debit or credit the enrolled account that I use with my payment card. I authorize National Payment Card Association or its assigns, when the payment card is used for purchases, to debit my account for the amount indicated in the tender amount of my payment transaction. In the unlikely event this transaction (for the amount tendered) is returned unpaid, I agree that a return fee will be collected by the same electronic means mirroring fines permitted by State laws.|
NOTE: You may also incur separate fees from your Financial Institution (Bank) for returned transactions. Because of this, we highly recommend that you have Overdraft Protection on your checking account to avoid additional return fees when using this card.
I acknowledge that I have voluntarily provided certain information to National Payment Card Association in order to participate in this program. I further acknowledge that, by authorizing this enrollment, the checking account that I am providing has sufficient funds that will not allow the bank validation process to go negative and that the account is owned by me and is a valid account to transact business in the USA.