I hereby authorize IDENTITY MEDIA SERVICES to initiate electronic payments to my/our account indicated on this form for payment of charges generated by IDENTITY MEDIA SERVICES on the day in which the bill is due. I also authorize the financial institution named to charge my checking, savings, or credit card account in payment of IDENTITY MEDIA SERVICES billings. I understand that this authority will remain in effect until IDENTITY MEDIA SERVICES receives written notification from me/us of our termination of this service in such time as to afford IDENTITY MEDIA SERVICES and my financial institution a reasonable opportunity to act on such notification. Should the funds not be available from my checking, savings or credit card account, a NSF fee of $25.00 will be assessed. Refusal of two (2) payments due to insufficient funds within a 12 month period will result in a cancellation of the automatic withdrawal. I understand I am solely responsible to inform IDENTITY MEDIA SERVICES of changes to my checking, savings, or credit card account, including but not limited to changes in name, account number or expiration date and I am responsible to pay any penalties incurred to IDENTITY MEDIA SERVICES not being informed of these changes. I understand if there is a current or previous balance on my account upon submission of this form, the automatic withdrawal will not initiate payment on the balance until the following month’s balance is to be paid. Payment of the current or previous balance needs to be made in the usual manner.
