Update Billing Information
Please fill out the fields below to update your billing information.
"
*
" indicates required fields
Name
*
First
Last
Organization
*
Email
*
Phone
*
Billing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Select Payment Type
*
ACH
Credit Card
Routing Number
*
Account Number
*
Name on Card
*
First
Last
Card Number
*
Expiration Month & Year
*
CVV/CVC
*
Authorization
*
I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify ONE SOURCE THE BACKGROUND CHECK COMPANY in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I understand that ONE SOURCE THE BACKGROUND CHECK COMPANY reserves the right to assess late fees for no payment after 30 days and may submit to collection agency after 120 days. All fees and interest incurred during past due payments may be subject to additional charges at ONE SOURCE THE BACKGROUND CHECK ’s discretion. I acknowledge that the origination of these transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this account and will not dispute these scheduled transactions accordingly; so long as the transactions correspond to the terms indicated in this authorization form.
I authorize ONE SOURCE THE BACKGROUND CHECK COMPANY to charge this account on the 6th business day of each month.
Name Signature
*
First
Last
To sign, confirm your first and last name.
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Notice:
Our office will be closed on December 24 and 25 to celebrate the holidays. Regular services will resume on Thursday, December 26. Thank you for your patience.
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