One Time Payment Authorization
Please complete this form to authorize EGNV, Inc. dba EG Threads to make a one (1) time debit to your checking or savings account. By submission of this form, you give us permission to debit your account for the amount indicated upon receipt of this form. This is
permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.
Signer on Account
I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as this form has been submitted or within three (3) business days. In the case of the payment being rejected for Non-Sufficient Funds (NSF) I understand that EGNV, Inc dba EG Threads may, at its discretion, attempt to process the charge again within
30 days, and I agree to an additional $75.00 charge for each attempt returned NSF A separate transaction from this authorized payment will be made to collect all incurred fees. I
acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. With my signature below, I will not dispute EGNV, Inc dba EG Threads billing with my bank so long as the transaction corresponds to the terms indicated in this agreement.