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Authorization Agreement for Preauthorized Payments

By checking the box, I authorize the financial institution (bank) or credit card company named on the form to charge my credit/debit card to pay my annual UGI HVAC Enterprises, Inc. Service Agreement on a monthly or quarterly basis. I agree that each debit or charge to my account shall be the amount shown on my original Service Agreement or renewal statement. I have the right to cancel this agreement for pre-authorization payments at any time upon five (5) days notice by calling or writing to UGI HVAC Enterprises, Inc. (“UGI”). I acknowledge that canceling this agreement for pre-authorization payments does not cancel or terminate my Service Agreement and I agree to pay any unpaid balance on my Service Agreement in full. I further acknowledge that my bank and/or UGI reserve the right to terminate this payment option and/or my enrollment.

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