Electronic Check Payment Submission

This form is used to process your one time ACH Debit to your checking account.

Date Entered*

This transaction may be post dated if necessary for the transferring of funds. Please put any detailed information in the next field "Comments to Processor".

Comments for Processor

If your check needs to be held until a specific date because you are transferring funds etc. Please put your instructions for it's processing here. If no comments are submitted the check will be processed as the date that it is entered. In can take up to 10 business days for your transaction to process to your account.

First Name*

Middle Initial (Not Required)

Last Name*

Address # 1*

Address # 2 (Not Required)

City*

State*

Zip Code*

Home Phone #*

Work Phone # (Not Required)

E-mail:*

Routing #*

This is a 9 digit number (typically the first 9 digits on the far left on the bottom of your checks.

Account #*

The amount of number here can vary. They should be the first numbers directly following the routing numbers. Please do not include any number after characters or spaces those are typically your check #. Please do not use deposit slips to obtain this information it may be inaccurate.

Check #

If you don't not enter a check # we will use the date of submission as your check #.

Amount*

Acceptance of Terms

By providing your bank account information and check box authorization today, you are authorizing Limitless Renovations Statewide, LLC to create an ACH debit to your account an that this Check by ACH may be drafted from your account as early as today. In the event your Check by ACH is returned from your bank unpaid for insufficient funds, you further agree that a fee of $50.00 or as allowable by law shall also be charged to your account via draft or ACH debit. Do you authorize Limitless Renovations Statewide, LLC to proceed with this Check by ACH please check the box. A Check by ACH will be drafted from your bank account with the information you just provided Please allow up to 10 business days for this transaction to post to your account. Should you have any questions regarding your payment please contact our CFO Sandra Adams at 678-471-5827 or email her at sandra.adams@lrenovations.com.

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