MLG - Telecheck Authorization

Recurring telecheck payments allow you to make automatic payments for current and future orders to your bank account after you have approved your order. A receipt will be emailed to you when your account is charged.

Company

Name on the check

Account Number

Routing Number

Check Type

Driver Licence (or Tax ID for businnes) Number

Street

City

Zip

State

Phone

I certify that I am the authorized holder and signer of the bank account referenced above. I authorize Monster Lead Group LLC to charge the bank account indicated in this authorization form according to the terms of their agreement. I agree to notify the business in writing of any changes in my account information or termination of this authorization. I hereby certify that I will not dispute the charges with my bank account provided the transactions correspond to the terms indicated in this authorization form.