Bank Account Auto Pay Enrollment

Bank Account Auto Pay Enrollment

Authorization Agreement for Automatic Debit Payment (ACH) for Pest Control/Termite Services

In order to make bill payments more efficient and easy for our customers, Hilton Head Exterminators offers the option of your service being automatically charged to your banking account each time the service is completed. If you would like to enroll, please completely fill out the form below and return in the mail.

First Name
Please enter your first name.
Last Name
Please enter your last name.
Account Number
Please enter your account number
Routing Number
Please enter your routing number
Financial Institution
Please enter your financial institution
Type of Account
Please make a selection.
Service Address
Please enter your service address.
Billing Address
Please enter your billing address.
Signature
Please enter your first name.

I authorize Hilton Head Exterminators, Inc. to automatically charge my bank account for each service after it is performed. I may cancel this request at any time by contacting Hilton Head Exterminators.