ACH Authorization

Northstar Aquatics

ACH Payment Authorization

One-time electronic bank debit authorization form

Account Holder Information

First Name *

Required

Last Name *

Required

Email Address *

Enter a valid email

Phone Number

Billing Address *

Required

Bank Account Details

📋 Where to find this info Your routing number (9 digits) and account number can be found on the bottom of a check, or in your online banking portal.

Bank Name *

Required

Account Type *

Required

Routing Number *

Must be exactly 9 digits

Account Number *

Required

Payment Details

Payment Amount ($) *

Enter a valid amount

Payment Date *

Required

Payment Description / Invoice Reference

Authorization & Signature

By signing below, I authorize Northstar Aquatics to initiate a one-time ACH debit entry to the bank account listed above for the payment amount indicated. I understand this payment will be processed through the ACH Network and may take 2–3 business days to settle.

I understand I may revoke this authorization by contacting Northstar Aquatics at least 3 business days before the scheduled debit date. A copy of this authorization will be provided upon request and retained on file per NACHA requirements.

SIGNATURE *

Please provide your signature

Printed Name *

Required

Date *

Required

✓ Authorization submitted successfully. A confirmation will be sent to your email.

The face of the moon was in shadow

Almost before we knew it, we had left the ground. All their equipment and instruments are alive.Mist enveloped the ship three hours out from port. The spectacle before us was indeed sublime.A red flair silhouetted the jagged edge of a wing.

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