One-Time ACH Payment Authorization

Sign and complete this form to authorize EGNV, Inc. dba EG Threads to make a one (1) time debit to your checking or savings account.

By signing this form, you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

I
authorize EGNV, Inc. dba EG Threads to charge my bank account
indicated below for $
On
MM slash DD slash YYYY
This payment is for Invoices:
Billing Information
Bank Details
Bank Details*
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I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted transaction date. 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 $40.00 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 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.

MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.