[affinipay-payment title="Pay with eCheck" type=echeck account=l3rzQ_DATQyFpQATHBbvMg reference_field=yes customer_city_field=yes customer_state_field=yes customer_country_field=yes]
By clicking "Submit Payment", I am authorizing Douglas A Turner PC to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Douglas A Turner PC, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) that the ACH/electronic payment I am authorizing complies with all applicable laws.
