605-348-5578

info@dakotaq.com

ACH Authorization Form

Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment.
Check one:(Required)
I (we) authorize Footprints Design LLC dba DakotaQ Internet Services to electronically debit my (our) account and, if necessary, to electronically credit my (our) account to correct erroneous debits as follows:
Select One:(Required)
Select the type of account at the depository Financial Institution named below. I (we) agree that ACH transactions I (we) authorize comply with all applicable laws.
Debit Transaction Frequency(Required)
Amounts charged are related to monthly invoices sent at the beginning of each month.
I (we) understand that this authorization will remain in full force and effect until I (we) notify COMPANY in writing by email to sales@dakotaq.com that I (we) wish to revoke this authorization. I (we) understand that COMPANY requires at least 30 days prior notice in order to cancel this authorization.