Secure ACH Authorization Form

Secure Payment Authorization

Please complete the form below to authorize payments from your bank account.

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Bank Account Details

Identity Verification

Please provide a clear image of the front and back of your government-issued ID (e.g., Driver's License or Passport).

Authorization Agreement

I, the undersigned, authorize Mobile Bay Timepieces LLC to initiate electronic debit entries to my bank account listed above for payment of goods or services. I understand that this authorization will remain in full force and effect until I notify Mobile Bay Timepieces LLC in writing that I wish to revoke this authorization.

I understand that I must provide written notice of revocation at least three (3) business days before the scheduled payment date. I can revoke this authorization by sending an support@mobilebaytimepieces.com.

I certify that I am an authorized user of this bank account and that I will not dispute this scheduled transaction with my bank, provided the transaction corresponds to the terms indicated in this agreement.