Update Payment E-Check

Account Details

E-Check Authorization Form

The purpose of this form is to authorize Wagner Tax to debit your checking account for ongoing tax, accounting, or payroll services. The amount of the payment and frequency of the payment follows the terms discussed and submitted to you by your representative at Wagner Tax. By submitting this form you are authorizing Wagner Tax to use this payment method in accordance with your agreed upon recurring payment for the services being provided. This payment method can be canceled anytime by phone, Email, fax, or in writing.

Company Name *

First & Last Name Of Person On Account *

Type Of Bank Account *

Consumer Checking (Personal)

Business Checking

Other

Please Choose One

Bank Name

Bank Account Number

Bank Routing Number

Your Cell Phone Number *

Your Email Address *

Electronic Signature *

Please Type Your Your Signature — An"electronic signature" is a method of signing an electronic form that— (A) identifies and authenticates a particular person as the source of the electronic signature; and (B) indicates such person's authorization and approval.

This form does not authorize Wagner Tax to alter your recurring charges for services we provide. This form should only be used when a customer needs to update or change their Payment Method on account.