Electronic Funds Transfer Form

Real Green will take the total cost of your applications over the course of a 12-month period and divide it into convenient monthly payments.

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

Please bill my           on the         
 *If the withdrawal date falls on a holiday or weekend the draft will occur the next business day.

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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