Electronic Funds Transfer Agreement

Thank you for choosing Real Green,

We Stand behind all of our services. If you are in need of extra attention, please give us a call or use our convenient
online service request form. It can be found at: www,RealGreenLawns.com

In an effort to keep our prices low, we offer this easy way for you to pay for services provided by us.
It reduces paper, our time in the office and it standardizes the payment amount and the date due.

Personal Information

Your Name                    Service Address                

City                 State                 Zip               

 Cell Phone                Home Telephone                Office Phone       

E-Mail Address                  Please re-enter  E-Mail Address             

 

 

This is a       

 

Billing Information

Please bill my        
 *If the withdrawal date falls on a holiday or weekend the draft will occur the prior business day. All services and programs include a 3.00 E-Check Discount. $3.00 will be added to all other payment types, except E-Check.
 

Bank Name     Account Holders Name

Routing Number    Checking Account Number 

Please Re-enter:

Routing Number    Checking Account Number 

Or

Credit Card Number   Expiration Date   

Please Re-enter:

Credit Card Number   Expiration Date   

Mailing Address of Bank/Credit Card Statement:  

Street Address     City     

State     Zip 

This agreement authorizes Real Green to automatically debit my account         for payment on my account. If the payment date due falls on a weekend or Holiday, the payment will be processed the prior business day.

Please enter the following text in the security box:            

If you understand and agree to the above; "Electronic Funds Transfer Agreement", please click I agree.