Payment Authorization

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Payment Authorization

  • The Account Holder identified below, hereby authorizes Capstone Law, LLC to debit my account identified below in the amount indicated below for each billing period (on the monthly anniversary of the date set forth below) until the balance owed to Capstone Law, LLC is paid in full or I otherwise revoke this authorization in writing. I agree that no prior-notification will be provided to me prior to withdrawal hereunder. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Capstone Law, LLC in writing of any changes in the account information or termination of this authorization at least 7 days prior to the next scheduled billing date. I understand that a payment that is scheduled falls on a weekend or holiday, the payment may be processed on that date or on the next business day. I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. I understand and agree that a $25 late fee will be assessed for any payment not received on or before the applicable due date. I understand that Capstone Law, LLC may at its discretion attempt to process the charge again within 3 days up to three times. I certify that I am an authorized user of the provided card and will not dispute these scheduled transactions with my card company, so long as the transactions correspond to the terms indicated in this authorization form. I understand that it is the client's responsibility to ensure that the monthly amount meets the payment term requirement contained in the applicable agreement.
  • Date Format: MM slash DD slash YYYY
  • I hereby authorize Capstone Law, LLC to charge my bank account and/or debit card the Minimum Monthly Amount as required by my agreement with Capstone Law beginning on the Commencement Date and then periodically according to the Payment Frequency listed herein, until the balance is paid in full.


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Tricia H.

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