Make a Secure Recurring Online Payment

As the account holder (or authorized user) attached to this payment, I permit Elevate Care LLC to debit the amount above on today's date (or next business day) as an electronic funds transfer via ACH or credit/debit card. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF), I understand that Elevate Care LLC may at its discretion attempt to process the charge again, and agree to an additional $25 charge or amount allowable by law for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH 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 with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form. I understand that this authorization will remain in effect until I cancel it in writing or upon expiration of payment terms, and I agree to notify Elevate Care LLC in writing of any changes in my account information or termination or revocation 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. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates.