Internet Services of the Low Country

Authorization Agreement for Pre-authorized Payments

I (We) authorize ISLC, Inc. to honor pre-authorization checks drawn by ISLC, Inc. on my (our) checking account indicated below for monthly payments to ISLC, Inc. It is understood that submitting a pre-authorized check to the bank as my (our) payment becomes due shall constitute valid notice of such payment due on my (our) account. When my (our) bank honors the check by debiting my (our) account, such check shall constitute as receipt for payment. Should any pre-authorized check not be honored by my (our) bank when received by them, it is understood that the payment due to my (our) account is to be made by credit card, cash, or money order in the amount of said payment, and shall incur a $30.00 returned check debit fee. If you have any questions, please call 843-770-1000 ext. 251 (or toll free from outside Beaufort 888-828-4752 ext. 251).

I have read and agree with the statements on this authorization

Customer Signature ____________________________________________
 


NAME: _________________________________ CUST ID# _________________ DATE ___________
                       (As it appears on check)

FULL NAME OF BANK __________________________________BRANCH______________________

BANK ADDRESS __________________________CITY________________STATE___ZIP___________

BANK ABA/ROUTING # ______________________CHECKING ACCOUNT # _____________________
 

  

Instructions:

  1. Print the form
  2. Sign and fill out the form completely
  3. Attach a voided check (it has to be a voided check and not a deposit slip)
  4. Send the form and voided check to:  ISLC, Inc., 14 Savannah Hwy, Ste 14, Beaufort, SC 29906

If you have any questions, please call 843-770-1000 ext. 251 (or toll free from outside Beaufort 888-828-4752 ext. 251).