Tenant AutoPay Form

Download the Form Here, or Fill Out the Application form Below

AutoPAY Form

Our AutoPAY plan allows you to have your membership fees automatically drafted from your checking account monthly. You will be sent an email confirmation each month verifying that the payment has been deducted from your checking account or charged to credit card. Please keep a copy of this form for your records.

AutoPAY Form

Full Name*

REFS Account Number*

Address*

City*

State*

Zip Code*

Type of Account to Setup AutoPAY*

Checking Account

Credit Card

Credit Card Set-Up

Credit Card Set-Up

Payment Type

Check

Certified Funds/Money Order

Credit Card

Would you like to enroll in AutoPAY?

Yes

Cardholder Name (as it appears on card)

Credit Card Number

Expiration Date (MM/YY)

CVS (Last 3 Digits on Back of Card)

Billing Zip Code

Signature

Upload Signature

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I request Berkshire Hawthorne Agents to enroll me in the AutoPAY Plan. I authorize Berkshire Hawthorne Agents to begin deductions from my account indicated above. I understand that I have the right to cancel AutoPAY at anytime by providing Berkshire Hawthorne Agents with written notice up to three business days prior to the time my account is scheduled to be charged. I understand that Berkshire Hawthorne Agents, and/or financial institution indicated reserve the right to end this payment plan and my participation therein at anytime. I understand that in event the debit, in connection with my account, is returned by a bank or other depository institution because of dishonor, a non-refundable check fee of $40.00 will be imposed for each such return.

Signature

Upload Signature

Date