Commercial Online Bill Pay

"Sign up today for auto-pay save time and stamps. No more regular bills to mail, just fill out the

easy payment form and we will do all the work.Once your service has been completed, we will automatically deduct your pest control service charge from your credit card or checking account. It's that simple."

Or if you wish you can download and print the Commercial easy payment form.

Print Form

Note: Mandatory fields are marked with an asterisk ( * )

Please Verify Billing Address & Contact Information:

Company Name *

Service Rate *

Attention To *

Billing Address *

Billing Address 2

Billing Phone*

Billing Fax *

Billing Contact Person *

Title *

E-Mail Address *

Please Verify Billing Address & Contact Information
(IF DIFFERENT):

Service Name *

Service Address *

Service Address 2

Service Phone *

Service Fax *

Service Contact *

Title *

Please Initial One of the Following Payment Methods:

	Automatic Payment Program: You can pay for your service with your credit card or bank checkcard by joining our automatic payment program. Simply complete the authorization below and on the day following your service, your credit cardor checkcard will be charged.
	SAVE 4% by Paying a Year in Advance: The easiest way to pay for your service is to pay for the entire yearinadvance with a single payment. If you choose this option, Adios will give you a 4% discount off the present rate.
	Billing (Pay Net 30 Days): Adios Pest Control, Inc. will pre-bill at the beginning of each month. This statementwillshow the month's scheduled services plus any past due amount. (Please verify billing information).
	Pay Your Technician: Our technicians can take your payment in the form of a check, credit card, bank checkcard orcashafter your service has been completed to your satisfaction.

AUTOMATIC PAYMENT AUTHORIZATION

I (we) authorize the credit card company listed below to tender payment to Adios Pest Control, Inc. for servicesrendered, when it is charged and to post the payment to our account.

Card Number *

Expiration Day*

Card Holders Name*
(As it appears on card)

Adios Pest Control, Inc. is authorized to initiate debit entries against our credit card account listed above for theregularly scheduledservices listed above performed by Adios Pest Control, Inc. at such times when these amountsbecome due. I (we) authorize thecredit card company to accept any debit entries initiated by Adios Pest Control, Inc. tobe debited from the account. I (we) have theright to cancel this automatic payment authorization by submitting to AdiosPest Control, Inc. written notice 30 days in advance of theintended termination of this authorization, this authorizationwill remain in effect until Adios Pest Control, Inc. has received that writtennotification of termination. It is the customer'sresponsibility to copy or notify the credit card company that this authorization is beingcancelled. Cancellation of theautomatic payment authorization does not cancel the pest control service agreement or the customer'sresponsibilitiesthere under.

Date *

Signature *

For Office Use Only

Processed by *

Date Entered *