First Insurance Funding ACH Form

By signing below, I certify that I am an authorized representative of the Company indicated above and that I have the authority to enter into this Agreement on the Company's behalf. Company understands that this Agreement will remain in effect until it is canceled in writing, and agrees to notify FIRST in writing at least 15 days in advance of any changes in its Designated Account information or termination of this Agreement. Company understands that because these are electronic transactions, it will have limited time to report and dispute errors. In the case of an ACH debit attempt being rejected for Non-Sufficient Funds (NSF), Company understands that FIRST may at its discretion attempt to process the debit again within 30 days, and agrees to an additional NSF charge, as allowed by applicable law, for each subsequent debit attempt that is returned NSF. FIRST reserves the right to cancel this Agreement at any time for any reason, including but not limited to ACH debits being returned NSF, and Company remains liable for timely payments under the terms of the PFA. Company certifies that the Designated Account is enabled for ACH transactions, and agrees to reimburse FIRST for all penalties and fees incurred as a result of Company's bank rejecting ACH debits or credits as a result of the Designated Account not being properly configured for ACH transactions. Company acknowledges that the origination of ACH transactions to its Designated Account must comply with the provisions of U.S. law.
Company authorizes FIRST to initiate recurring ACH debits and credits to the Designated Account to collect all amounts due under the PFA according to the terms of this Agreement.