ACH Direct Debit

CUSTOMER MANDATE

Authorize GXPort AI to collect recurring payments directly from your bank account. Your details are encrypted and stored securely.

Bank-grade encryption NACHA compliant Revoke anytime No card required

Account Holder

Full legal name *Business name (optional)Email *Phone

Billing Address

Street address *Apartment / suiteCity *State / province *ZIP / postal code *

Bank Account Details

Bank name *Account type *Routing number (9 digits) *Account number *

For your security, only the last 4 digits of your account number are stored.

Payment Schedule

Debit amount (USD)Frequency

Authorization

I authorize GXPort AI to initiate electronic debit entries to the bank account identified above, and for my financial institution to debit the same account, in accordance with the payment schedule selected. I acknowledge that I must provide notice to revoke this authorization in advance of the next scheduled debit. This authorization remains in full force until revoked.

E-signature (type your full name) *Date

I have read and agree to the Terms of Service and authorize GXPort AI to debit my account as described above.