FREEDOM FASTax Service

Guarantee of Payment Authorization

The purpose of the Guarantee of Payment Authorization is to insure payment where services are rendered before payment has been received.  

First Name

Last Name

Bank (Example: WaMu, B of A, Citibank, etc.)

  Your Check

Memo __________________           ___________________________________

Bank Routing Number (9 digits)      Account Number     Check number

:'123456789': (lower left corner)  7889024768 000"'         1001

Routing Number

For Tax Refunds and Authorization

Account Number (don't include check number)

If Payment Guarantee is by credit card, complete the following...

Otherwise, skip down to "I Agree" button and complete authorization.

Card Number

Credit Card

Expiration Date

Card Code: (3 digit code on back of card)

Name on Card

Billing Phone Number

Billing Address

City

State

Zip

Email Address

Print Name (Electronic Signature Authorization)

VISAMASTERCARD

MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Year2009201020112012201320142015201620172018

Guaranty of Payment Authorization I/We, the undersigned, hereby promise to pay Freedom Financial Services, or FREEDOM FASTax Services, hereinafter referred to as “Freedom”, for any and all  services rendered in the  performance of tax preparation, accounting, or any and all other related duties. In the event such services have been rendered and (15) Fifteen Days has elapsed since a return has been efiled or an invoice was presented to me/us in person or sent to my/our last known address, Freedom is hereby authorized to debit funds from any banking accounts and/or charge accounts, which are held in my/our name, in the amount due for such services and agree to hold Freedom harmless for any consequences as a result of such debit or charge activity.

I AgreeDisagree

By my electronic signature above, I agree to the terms of the Guarantee of Payment Authorization.