Electronic Payment Authorization

Complete all of the following fields to authorize Schroeder & Associates, PC to initiate electronic debit entries to the account listed below for payment of your invoice.

* All fields are required

* Client Full Name:

* Phone Number:

* Payment Date (DD/MM/YYYY):

* Payment Amount:

* Checking or Savings:

* Account Number:

* Routing Number (9 digits):

* Your Bank Name:

* Check this box to agree with the following ACH Terms and Conditions