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: -- Checking ---- Savings -- * Account Number: * Routing Number (9 digits): * Your Bank Name: * Check this box to agree with the following ACH Terms and Conditions
