Agent/Broker Payments

I hereby authorize Zoom Professional Services to duplicate the attached, or otherwise provided checks, in bank draft form. This authorization is valid for the first transaction installment as well as future installment payments in the amount that has been agreed upon between myself and Zoom Professional Services to satisfy the sum owed to the insurance carrier for the policy number listed above. The transaction amounts will be for exactly the amount listed on each installment check and the checks will be drafted on, or after the dates listed on each installment check. I have read and agree to all of the terms and conditions on this page and any other contract or document that accompanies this agreement. I certify that I am the authorized account holder for this checking account. I understand this is a legal binding agreement between Zoom Professional Services and the undersigned and I will receive a copy of each check draft in my statement when the item has cleared. I also understand that if my item or items, are returned unpaid for any reason, including, but not limited to, NSF, uncollected funds, invalid or closed account, stop payment, or any other reason, the company will attempt to redeposit the item or items, and may choose to assess a returned check charge in the same or separate draft for $25, or the maximum returned check charge allowed in your state.

I understand that a processing fee may be charged by the credit card processor where allowed by law, and that Zoom and its affiliates do not receive any portion of this fee*. I understand and agree that any late fees that have accrued on my account to date may be added to this charge. I acknowledge that I currently have sufficient credit available on this card to process this transaction and any recurring transactions.