Sample Payment Authorization Language

Sample written language for an eCheck recurring transaction payment authorization

• https://www.authorize.net/content/dam/documents/en/echeck-user-guide.pdf

[The current date] 

I, [customer’s name], authorize [merchant’s name] to charge my [bank account type] starting on [month, day, year] and on the [day of the month] of each month following through [month, day, year] for the amount of [$X.XX] for [description of the transaction]. 

My account information is as follows: 

Bank Name: [name of the customer’s bank] 

Bank ABA Routing Number: [customer’s bank’s ABA routing number] 

Bank Account Type: [checking, business checking, savings] 

Bank Account Number: [the customer’s bank account number] 

This payment authorization is valid and to remain in effect unless I, [customer name], notify [merchant’s name] of its cancellation by sending written notice [or other method preferred by merchant]. 

[customer’s signature] 

[customer’s name]