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Account number

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Payment Information

First name

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Bank account number

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Address 1

Address 2

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Zip

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You are agreeing to pay $ plus a Fee of $ (%) for a Total of $.

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I authorize Cannon Law Associates to debit the above payment of $ from the bank account listed above. I also authorize Cannon Law Associates to store this information in compliance with payment processing regulations and to debit the bank account listed above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact Cannon Law Associates prior to the payment being submitted to process.

I authorize Cannon Law Associates to debit the payment schedule outlined from the bank account listed above. Each payment will be processed on or after the scheduled date. I also authorize Cannon Law Associates to store this information in compliance with payment processing regulations and to debit the bank account listed above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact Cannon Law Associates prior to the payment date.

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