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QB Services

This is an authorization agreement for ACH Payments (Bank to Bank payments) In Favor of Company Name: "QB Services" I authorize this above named Company and the financial institution listed below to electronically debit my Bank account to transfer the sum of the dollar amount $ in favor of “QB Services”.

Bank Details :

Bank Name :

Account Number : Routing Number :

This authority is given for one-time transfer only as per the details stated above and will remain in effect until the transfer of money is complete.

Staple, in this box, a VOIDED check or deposit ticket for the account indicated above

Print Name : Social Security Number (Last 4 digits) :

December 16, 2025

Return this completed form to the Company named above.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

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Signed by QB Services
Signed On: December 16, 2025

Timestamp

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May 22, 2025 5:32 pm CST

QB Services Uploaded by QB Services - info@qbhelpdesks.com IP 103.158.136.137