Welcome to Relocation Services Payments!
ACH AUTHORIZATION FORM
Electronic check authorization form to secure the initial payment.
Job Number
(Required)
Please enter your 7 character job number located at the top right side of your Binding Moving Estimate. Letter must be included.
1. Customer Information
First Name
(Required)
First name as it appears on your bank account:
Last Name
(Required)
Last name as it appears on your bank account:
Phone
(Required)
Please enter your 10 digit mobile phone number:
Email
(Required)
Enter Email
Confirm Email
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
2. Banking Information
Payment Amount
(Required)
Please enter your initial payment amount listed on your Binding Moving Estimate:
Bank Name
(Required)
Please enter the name of your banking institution:
Bank Account Type
(Required)
Please select checking or savings:
Checking Account
Savings Account
Bank Routing Number
(Required)
Please enter the ACH routing number of your banking institution:
Bank Account Number
(Required)
Please enter the ACH account number of your banking institution:
3. Terms and Conditions
(Required)
I irrevocably authorize the relocation merchant services to initiate funds from the checking account indicated and hereby personally guarantee the funds. I authorize the amount entered as valid and true. All payments will be processed no later than two business days from the authorized date. (Note: IF the sum exceeds $4,000.00 the funds will be debited as separate transactions. I have read and agreed to all terms and conditions on this page and any other contract or document that accompanies this agreement (i.e. Binding Moving Estimate). I certify that I am the authorized account holder for this checking / savings account. I understand that all returned items due to invalid account information or insufficient funds are subject to a fee of up to $100.00. I understand this is an irrevocable legally binding agreement.
I agree to the Terms and Conditions outlined above:
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