Billing Information as it appears on your Bank Account.
I certify that I have signatory capacity with this account financial institute to authorize charges on this bank account on behalf of my company. If the charges are declined, I personally and individually guarantee the payment of declined charges. I acknowledge that future orders may be authorized to this bank account, subject to the same terms and conditions as this authorization. A confirmation will be provided if I request it. I agree to notify AA Dental Design Inc. of any changes to my account information at least 15 days prior to the next billing date.
