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 *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Payment Information

Name (as it appears on credit card) *

Credit Card Number *

Expiration Date *

Credit Card Type *
Visa  Mastercard

Amount (monthly dues) *

I would 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) *