Auto Payment Authorization Form

Please fill out the form below to authorize monthly automatic payments. If you have any questions, please contact us.

Contact Information

Company Name *

Contact Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Payment Information

Name *

Please provide your name as it appears on the credit card.

Credit Card Number *

Expiration Date *

Credit Card Type *

Visa
Mastercard

Amount (Monthly Dues) *

Would You Like to Receive Paperless Statements?

Submit Application

By providing a digital signature and submitting this application, I authorize American Spa and Pool Pros to deduct my monthly ASAPP dues using the credit card number above. Note: Auto pay payments will be deducted on the 15th of each month. If you need to request another date, please contact us.

Digital Signature (type your name) *

Submitting your digital signature is legally binding.

Name