SLIPLINK AUTHORIZATION TO DO AUTOMATIC CHECK DRAFTING

Sliplink Network  will accept Checks, Money Orders, and  Discover, Visa and  MasterCard (Maestro) credit card payments.
NOTE! all bills are due on the 1st day of the month late after 5th and deactivated after the 10th.
Please print and completely fill out the following form to ensure timely processing. Check, Credit card and address information is confidential; the completed form should be faxed or mailed to Sliplink Network at:

FAX TO: 1-916-488-3311 

Mail To ( Allow 10 working days for mail )

Sliplink Network USA
A BERBER CORP / ULTRA TECHNOLOGY LIMITED. INC. COMPANY
P.O. Box 351
Sacramento, CA 95812-0351
USA

Your Name: __________________________________________________________
Company  (if any) _____________________________________________________
Your Address ________________________________________________________
Phone Number: _______________________________________________________

Name On check:__________________________________________
Bank Name:  ___________________________________________
Bank Routing Number ____________________________________ 
Your Account # __________________________________________

I authorize Sliplink Network, USA, to use automatic check drafting as the method of payment for my services through their company.  I realize that no signature is needed on these checks and that if I dispute a charge through my bank that this will constitute a breach of contract and result in immediate deactivation of my account. . I understand cancellation of this authorization should be done via certified mail for my protection and verification of cancellation. I understand that cancellation must be received by Sliplink before the 1st of the month I wish to cancel. I understand there is NO partial month billing any part of the month is billed in full   

 Sliplink Network USA Customer. (initial one)

 ____  - please use Check Drafting for my monthly invoice.

 ____  - please use Check Drafting only on request.

 ____  - please use Check Drafting on a one-time basis: Amount = $________

 I have included a blank voided check along with the signed copy of this automatic check authorization form
Please Note: charge backs and declined transactions may be subject to an additional handling fee.

 Signature ___________________________________________________ Date ____________

PRINT NAME HERE __________________________________________________________

Questions regarding check payments can be sent to billing@sliplink.net  or call 916-448-8099

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INCLUDE VOIDED / OR NOT CHECK OR CLEAR PHOTO COPY OF CHECK HERE  ( REQUIRED )

 Adobe PDF Check Authorization forM in PDF Format