Recurring Payment Authorization Form
Schedule your payment to be automatically deducted from your bank account, or charged to your Visa, MasterCard, American Express or Discover Card. Just complete and sign this form to get started!
Recurring Payments Will Make Your Life Easier:
Here’s How Recurring Payments Work:
You authorize regularly scheduled charges to your checking/savings account or credit card. A receipt for each payment will be sent to you and the charge will appear on your bank statement as an "ACH Debit." Precision LTC Pharmacy will contact with an amount prior to charging your account.