BillMed Management LLC is pleased to offer an Automatic Payment Plan to simplify the payments of your Invoices. With the Automatic Payment Plan, your payment is automatically deducted from your Checking Account on your due date. You have one less check to write and we receive your payment on time.

I hereby authorize BillMed Management LLC to initiate debit entries to my account indicated below at the depository financial institution named below, hereinafter called the Depository, and to debit the same to such account. I acknowledge that the Origination of Automated Clearinghouse (ACH) transactions to my account must comply with the provision of U.S. law.

This authorization will remain in full force and effect until I notify the Company to cancel my Automatic Payment, a minimum of three (3) business days before the date of withdrawal, in writing via email or standard mail.

THERE IS ABSOLUTELY NO EXTRA COST TO YOU!