I [FIRST NAME] [LAST NAME] authorize DPF Solutions LLC to initiate Automatic Clearing House (ACH) or Electronic Funds Transfer (EFT) or Remotely Created Check (RCC) from my designated bank account at the financial institution identified above. I authorize DPF Solutions LLC to debit my bank account according to the schedule of debits provided to DPF Solutions LLC by me or as otherwise provided by agreement. I understand that debits will be withdrawn on the due date unless otherwise indicated and that sufficient funds must be available in designated account at least two (2) business days prior to the actual date of the debit. This authorization is to remain in force until the schedule of debits is completed or DPF Solutions LLC has received written notification from me of a change or I revoke my authorization by contacting DPF Solutions LLC at 1800-875-1912 in such time as to give DPF Solutions LLC a reasonable opportunity to act on it. I authorize DPF Solutions LLC to recover funds by ACH/EFT/RCC debit from my bank account in the event of an error or in the event that a prior debit is returned for any reason, including non-sufficient funds. I understand that a service charge may be charged by your financial institution for every NSF draft. I understand I can call DPF Solutions LLC at 1800-875-1912 to cancel the automatic draft payments. Payments will be drafted on the payment due date of the original agreement.
• Total Balance Fitness & Nutrition provides educational and coaching services only. • We do not provide medical advice or treatment. • Results vary by individual, and no specific outcomes are guaranteed.