ACH Debit Authorization • Check by Email Form

Company Name: Amount USD $ Check #

Routing Number: Account Number:

I hereby authorize Think Ink Marketing Inc. to perform an ACH debit on the account designated above for the amount shown. I also understand that if this draft should be returned for insufficient funds or any other reason, a fee of $25 will be assessed plus reasonable collection and attorney fees should such be necessary.

Authorized Signature
Your Name:
Your Email:

Place Signed Check made payable to Think Ink Marketing in the box below.

Email To: [email protected]

Please add an image here (tip: You can take a photo with your phone if you don't have a scanner and email yourself, or fill out this form from your phone)

Voided Check

Keep original check for your files (do not mail the check to us)

16692 Burke Lane • HB, CA 92647 • 949 295 4250

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