Company Name: Audit1, LLC
Company Address: [Insert Company Address]
Email: [email protected]

By accepting this agreement, you (“the Account Holder”) authorize Audit1, LLC to initiate electronic debit entries to your designated bank account, and if necessary, to make credit entries and adjustments for any debit errors, in accordance with the rules of the National Automated Clearing House Association (NACHA).

These ACH transactions will be made for the purpose of collecting insurance premiums, policy fees, taxes, and other related charges associated with your insurance policy or policies managed through Audit1, LLC or its affiliates.

Terms of Authorization

1. Recurring Payments

This authorization is recurring and will remain in effect for the duration of each insurance policy term. Audit1, LLC will process payments as they become due in accordance with the billing schedule of your insurance policy or related agreements.

2. Notification of Charges

You will be notified of the amount and date of each withdrawal prior to the transaction in accordance with your policy’s billing terms.

3. Revocation of Authorization

You may revoke this authorization at any time by doing one of the following:

• Emailing a written notice to [email protected] or notifying your insurance agent or insurance company directly. Revocations must be received at least five (5) business days prior to the scheduled withdrawal date.

4. Account Information Changes

You agree to promptly notify Audit1, LLC of any changes to your bank account information to avoid payment interruptions.

5. Policy Term and Renewals

This authorization will automatically renew with each new or renewed policy term unless expressly revoked.

6. Termination by Audit1, LLC

Audit1, LLC reserves the right to terminate Agreement immediately if:

• The policyholder fails to report payroll, sales, or other exposure information timely.
• The policyholder incurs more than two (2) NSF occurrences.
• The policyholder directs their financial institution to reverse, reject, or unauthorize any previously approved transactions.

7. Electronic Acceptance

This agreement may be accepted electronically through Audit1, LLC’s online platform or secure portal. Electronic acceptance has the same force and effect as a signed document.

Bank Account Information

Bank Name | __________________________________________ |
Routing Number | __________________________________________ |
Account Number | __________________________________________ |
Account Type | ☐ Checking ☐ Savings |

Account Holder Authorization

By signing below, or by accepting electronically, I authorize Audit1, LLC to debit my account as
indicated above for insurance-related payments. I understand I may revoke this authorization.
Account Holder Name | __________________________ |
Signature | __________________________ |
Date | __________________________ |
For Office Use Only
Customer/Policy Number | __________________________ |
Policy Effective Date | __________________________ |
Authorized By (Audit1, LLC) | __________________________ |