UTS Employee Payment Form Auto-Pay Information Employee Name:* Employee Work Email* Name (as it appears on card/account)* First Last Please select a payment option: ACH/Bank Account** (Recommended, see below) Credit Card **ACH transfers are inherently more secure. When you make an ACH payment, it processes through an encrypted, secure system. The payment is then processed in a safe, secure environment, giving your credentials increased protection. Account Number* Routing Number* Account Type* Checking Savings Card Type*VisaMastercardDiscoverAmerican ExpressExpiration Date* Credit Card Number* Signature*By signing above you ("Client") are authorizing Trusting Connections ("TC") to automatically charge the account designated above to pay any service invoices. Client understands and agrees that for hourly service charges, TC will send an electronic invoice to the Client, detailing all charges for services rendered the week prior. Client will have 24 hours to review charges before final payment processing. Client understands and agrees that All TC clients must keep a valid charge account on file. Client also represents and warrants that he/she is the person whose name appears on the credit card, that he/she is authorized to use the credit card and that the information provided is correct. Client agrees to notify TC of any change in the credit/debit card or account number or expiration date. If TC is unable to charge the account on file and collect payment, additional fees may apply. Clients' account will also bear interest until paid, according to the terms and conditions outlined in separate service agreement. Date MM slash DD slash YYYY CAPTCHA