ACH Payment Authorization

You authorize scheduled charges to your checking/savings account. You will be charged the amount indicated from each previous billing invoice/statement. An email notification will be sent prior to ACH payment processing. A charge will appear on your bank statement as an "ACH Debit".

I   Authorize Petersburg Oil Company to charge to my bank account indicated below.

Billing Information




Bank Details
CheckingSavings

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Petersburg Oil Company 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, understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as I have received notification. In the event of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that at any time the charge will again be attempted to process within 30 days, and agree to an additional $25.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U. S. law. I certify that I am an authorized user of this bank account and will not dispute these transactions with my bank, so long as the transactions correspond to the terms indicated in this authorization form.

Signature

Date