Electronic Funds Transfer Form
All of our services do continue from season to season so if you choose to cancel, you may be eligible for a refund or have a balance owed depending on the total cost of services completed and the total amount of payments made.
Contact Information
Your Name Service Address City State Zip Daytime Telephone
Evening Telephone E-Mail Address
Billing Information
Bank Name Account Holders Name
Routing Number Checking Account Number
Or
Credit Card Number Expiration Date
Mailing Address of Bank/Credit Card Statement: Street Address City
State Zip
This application authorizes Real Green to automatically debit my account (plus tax) each month for services. You may cancel at any time by submitting a 30-day written notice. We will credit/debit the final balance from the chosen payment option within 10 days of the cancelled service to bring the final balance to zero.
If you agree to the above terms and conditions of the above payment program, please click “I agree”.
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