American First Financial
Secure Payment Form
Date: 01/02/25
Payment Summary:
IP: 3.17.174.204
Payment For:
(Account # or Name)
Payment Amount:
$
Branch Location:
choose
Central Phoenix
Mesa
North Phoenix
Flagstaff
Sierra Vista
Unknown
Transaction Fee:
$ 5.00
Total Check Amount:
$
Checking Account Information:
Account Holder Name:
Bank Routing Number:
Bank Account Number:
Address Line:
City:
State:
Zip:
Phone Number:
Email Address:
I agree to the terms below (Must be checked to proceed)
I authorize American First Financial to debit my checking account indicated above for the above indicated amount. I certify that I am authorized to initiate transactions on this account. I further acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree to notify American First Financial in writing of any changes in my account information or termination of this authorization 15 days prior to the next due date of the charges. I understand that cancellations must be made in writing and I will not dispute American First Financial debiting my checking account, so long as the amount corresponds to the terms indicated in this contract.