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.