Payment Authorization ACH Form – Supreme Oil & Service Corp.
75 South Broadway Suite 400, White Plains NY 10601

Payment Authorization ACH Form

Payment Authorization Form ACH - Terms and Conditions

**Please note: the following information must be completed before your request to become a customer will be processed.

**IMPORTANT - - Please send an image or attach a copy of a voided check with this form.

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PAYMENT AUTHORIZATION: Customer authorizes Supreme Oil to initiate ACH credit and debit entries to/from Customer’s stated account indicated above for amounts owed on invoices or statements that are provided to Customer and Customer hereby authorizes the financial institution named above (the “Institution”), to accept the ACH credit and debit entries. Authority to initiate ACH credit and debit entries shall remain in full force and effect until Supreme Oil has received written notice from Customer 30 days in advance of its termination of such authorization. Customer understands that Customer has the legal right to stop payment of an ACH credit or debit entry by notification to Institution; provided, prior to such action, Customer shall give Supreme Oil 30 days written notice to permit Supreme Oil to take any necessary actions to avoid disruptions in payments from Customer. Customer agrees to follow NACHA rules applicable to ACH transactions.

For all billing questions, the office is available M-F during work hours 8am-5pm. After hours are for EMERGENCY only. Due to high volume of calls and limited staff, please leave a voice mail, e-mail or text and we will reply in a timely manner. If you need immediate access to your account, please log-in to your account via the Supreme website to view the delivery history, balance due or to make payment.