Electronic Check (ACH) / Credit Card Authorization Form

What this form is for

Use this Electronic Check Credit Card Authorization.pdf form to set up Auto Pay (automatic recurring payments). Once approved, your payment will be processed automatically on your scheduled due date using either:

• ACH (electronic check / bank account), or

• Credit/Debit card

Before you start

• Please print clearly (or type, using built in form or PDF Markup).

• Make sure the name on the form matches the name on the bank account or card.

• To avoid delays, complete only the section for the payment method you want.

How to fill out the form

Choose ONE payment method below

Option A - Use ACH (Electronic Check / Bank Account)

✅ Fill out the TOP HALF (ACH / bank draft section) if you want to pay from a bank account.

You’ll typically need:

• Name on Check (Last, First)

• Your Address

• Bank Routing number (9 digits)

• Bank Account type (Checking or Savings)

• Bank Account number

• Email Address for Electronic receipt (Optional)

• Signature

Helpful tip: Routing and account numbers are usually found at the bottom of your check, or in your online banking.

Option B - Use Credit/Debit Card

✅ Fill out the BOTTOM HALF (Card section) if you want to pay by card.

You’ll typically need:

• Cardholder name

• Card Address

• Card number

• Expiration date

• Card Type

• CVV (security code)

• Signature

Step 3 - Submit the completed form

Send the completed, signed form using one of the methods below:

• Fax: +1 (660) 951 - 3999

• Text: +1 (660) 827 - 1500 - (text a photo or scan of the completed form)

• Mail:
  • Precision Computer
  • PO BOX 560
  • Sedalia, MO 65302

• Email (Least Secure Option): support@precision-computer.com

Security note: For your protection, please do not email bank/card details unless you are comfortable doing so, if your email is insecure or gets compromised, your information can be at risk, we recommend only to send if you are able to securely encrypt your emails. You may submit by mail, fax or call us instead.

Processing time

Please allow up to 5 business days for processing after we receive your completed form. Auto Pay will begin once setup is confirmed.