Fillable Office Ally Account Information

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Office Ally Account Information

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Questions? (360) 975-7000 option 4 2020-01-07
Customer Authorization
Recurring Auto Payment Form
To protect your personal information, submit this form via the following methods ONLY:
• Fax: (360) 953-8427
• Mail: Office Ally, PO Box 872020, Vancouver, WA 98687
• Email: Autopay@OfficeAlly.com
o When emailing, zip with password, then call: (360) 975-7000 option 4 to provide password.
Please allow up to 10 business days for Recurring Auto Pay form to be processed. An email will be sent to the email
provided to notify whether form was processed or not. If not processed, form must be resubmitted with corrections.
For security reasons, we do not retain/edit/update Recurring Auto Pay forms.
Office Ally Account Information
Today’s Date:
________________
Account #:
________________
Account # is located on your invoice/statement (upper right). It starts with U or A, followed by 6 numbers.
Company Name:
Contact Name:
Contact Email:
RECURRING AUTO PAYMENT OPTIONS – Choose and complete one option below
Option 1: Credit Card Payment
Cardholder Name:
As it appears on the credit card
Credit Card
Billing Address:
Street Address
City, State, Zip Code
Credit Card #:
Expiration (MM/YY):
_ _/_ _
I authorize Office Ally to charge my account on a regularly recurring basis to bring the account listed above current. I unde
rstand that it
is my responsibility to monitor my credit card charges and verify that payments are processed properly.
*Electronic signatures not accepted
Option 2: Electronic Check Payment
A copy of voided check is required for electronic check payment.
Name on Checking
Account:
Address on Check:
Street Address
City, State, Zip Code
Bank Routing #:
_ _ _ _ _ _ _ _ _
Bank Account #:
I authorize Office Ally to charge my account on a regularly recurring basis to bring the account listed above current. I unde
rstand that it
is my responsibility to monitor my bank charges and verify that payments are processed properly.
Bank Account Holder Signature:
*Electronic signatures not accepted
IMPORTANT NOTICE: You are responsible to keep your auto payment information on file current. Please submit a new authorization form for
any credit/electronic check account changes, including expiration dates. If your payment is not processed, it is your responsibility to contact Office
Ally for information or submit a revised form with current information. Office Ally accounts with outstanding balances are subject to being disabled
until payment is received. Please monitor your credit card/bank charges. You will continue to receive invoices for your records. Your account
balance can be viewed online in your Office Ally account under “Pay Office Ally Bill”. Payments will be processed by the end of each month.
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Office Ally Account Information

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Completed 24 September 2020

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