Automatic Billing Acknowledgment Form
Purpose: To ensure users acknowledge and agree to the terms of automatic billing for subscription services provided by Satoshi Terminal. This form outlines the payment schedule, cancellation policy, and responsibilities of the user.
1. Subscriber Information
Full Name or Entity Name:
______________________________________________Satoshi Terminal Account ID:
______________________________________________Contact Information:
Email Address:
_________________________________________Phone Number:
_________________________________________
2. Billing Details
2.1. Subscription Plan:
[ ] Basic[ ] Advanced[ ] Institutional[ ] Other (specify): _______________________________
2.2. Billing Frequency:
[ ] Monthly[ ] Quarterly[ ] Annually
2.3. Subscription Fee:
Amount:
__________ USDApplicable Taxes:
__________ USDTotal Billed Amount:
__________ USD
3. Automatic Billing Terms
3.1. Payment Method:
[ ] Credit/Debit Card[ ] Cryptocurrency (specify): _______________________________[ ] Bank Transfer
3.2. Billing Cycle:
The subscription fee will be automatically charged at the beginning of each billing cycle.
3.3. Payment Date:
First Payment Date:
__________________________Recurring Payment Date:
__________________________
3.4. Renewal Policy:
All subscriptions are set to auto-renew by default unless canceled by the Subscriber.
3.5. Payment Authorization:
By agreeing to this acknowledgment, the Subscriber authorizes Satoshi Terminal to charge the specified payment method for all subscription fees, including applicable taxes, until the subscription is canceled.
4. Cancellation Policy
4.1. Cancellation Window:
Subscribers may cancel their subscription at any time, but cancellations must be made at least 5 business days before the next billing date to avoid being charged for the next cycle.
4.2. Refund Policy:
No refunds will be issued for partial billing periods or unused portions of the subscription.
4.3. Cancellation Method:
Cancellations can be initiated via:
[ ] Satoshi Terminal Account Settings[ ] Customer Support (support@ii4i.net)
4.4. Post-Cancellation Access:
Subscribers retain access to their account features until the end of the current billing cycle.
5. Acknowledgments and Responsibilities
5.1. User Responsibility:
The Subscriber is responsible for ensuring their payment method is valid and has sufficient funds to cover subscription charges.
5.2. Failed Payment Policy:
In the event of a failed payment, the Subscriber will be notified, and access to services may be temporarily suspended until the issue is resolved.
5.3. Changes to Subscription Fees:
Satoshi Terminal reserves the right to adjust subscription fees with a 30-day prior notice to the Subscriber.
5.4. Agreement to Terms:
By accepting this acknowledgment, the Subscriber agrees to abide by all terms outlined in this form.
6. Authorization and Signature
"I, _________________________________________ (Full Legal Name), acknowledge and agree to the automatic billing terms, cancellation policy, and responsibilities outlined in this agreement. I authorize Satoshi Terminal to charge my selected payment method for subscription fees and applicable taxes as described."
Subscriber Signature:
______________________________________________Date (MM/DD/YYYY):
______________________________________________
7. Internal Use Only (For Satoshi Terminal Staff)
Form Received By (Name and Employee ID):
______________________________________________Date/Time of Submission:
______________________________________________Verification Checklist:
[ ] Payment Method Verified[ ] Billing Frequency Confirmed[ ] Subscription Tier Verified
Approval Status:
[ ] Approved[ ] Rejected[ ] Requires Additional Information
Comments/Notes:
______________________________________________
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