By clicking on the 'OK' button below, I hereby authorize COMPANY_NAME to deduct from my checking or savings account indicated ...

By clicking on the 'OK' button below, I hereby authorize [COMPANY_NAME] to deduct from my checking or savings account indicated above for payment of [COMPANY_NAME] services. I understand the authorization is to remain in full force and effect until [COMPANY_NAME] receives notification from me in such time and manner so as to afford [COMPANY_NAME] and my bank a reasonable opportunity to act on it.