Direct Debit Authorization Form
Please fill out this form so we can perform a one-off direct debit from your bank account.
Note: If you don't have all the account details available and are more comfortable with another payment method, please use the back button in your browser to go back and choose another payment option.
I Authorize Kampshoff Consultance inc. to charge my bank with the order amount. This payment authorization is valid and to remain in effect for this single purchase unless I, notify Kampshoff Consultancy Inc. of its cancellation by sending written notice via email within 12 hours of approving this authorization.
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Direct Debit Authorization Form
Agree & Sign