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Payment Type
Budget Payment to reoccur monthly - scheduled 1st business day of the month
Auto Payment after delivery for the full delivery amount - scheduled payment the Wednesday after the delivery
One Time Payment - put details in note section

ACH Authorization Disclosure

By signing below, I authorize Philly Fuels Inc. to initiate electronic debit entries to my bank account listed above and, if necessary, to initiate adjustments for any transactions credited or debited in error. This authorization will remain in effect until I notify Philly Fuels Inc. in writing to cancel it, allowing reasonable time for processing.

I understand that:

  • Funds may be withdrawn from my account on or after the scheduled payment date.

  • It is my responsibility to ensure sufficient funds are available

  • Returned or rejected payments may be subject to fees.

  • I may revoke this authorization at any time by providing written notice at least 10 days prior to the next scheduled transaction.

I acknowledge that the origination of ACH transactions to my account must comply with all applicable laws and regulations.

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