Authorization: By clicking the button to submit this form you authorize Gold Standard Consulting LLC to debit the bank account whose information you will provide for a one-time payment. The amount of the payment will be for exactly the amount that will be entered into the payment form. The payment authorization is to remain in full force and effect until you notify Gold Standard Consulting LLC of its cancellation by sending written notice in such time and in such manner to allow both Gold Standard Consulting LLC and the receiving financial institution a reasonable opportunity to act on it. After submitting this form you will have the ability to print or save a receipt to your computer
In the case of this transaction being rejected for Non Sufficient Funds (NSF) I understand that Gold Standard Consulting LLC may at its discretion attempt to process the charge again within 30 days, and agree to an additional $15.00 charge for each attempt returned NSF. I acknowledge that the origination of transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account and will not dispute this transaction with my bank; so long as the transaction corresponds to the terms indicated in this authorization form. I understand that for any items that are disputed there will be a fee assessed in the amount of $55.00.
I Certify that i am the authorized account holder for this bank account and hereby authorize the processing of this single draft payment payable to: