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I (we) hereby authorize Lee’s Tax City, LLC /dba: 1040TaxBiz to initiate ACH transactions to the banking institution and account named as indicated below for the purpose of tax preparation revenue transactions. This authorization is to remain in effect until 1040TaxBiz receives written notification of termination or change of account information.

The credit card will be charged for the following circumstances:

For the purpose of paying the initial $249.50 cost of the program as advertised.
In the event of a "Return ACH" when 1040 TaxBiz initiates ACH debit for weekly EFiles fees, the credit card will serve as a backup method for payment.

All payments Are Non-Refundable after 14 days. Payment will be due at the time the agreement is completed.

Please Upload Clear Image Of The Front Of Credit Card:

Please Upload Clear Image Of The Back Of Credit Card:

Which Type Of Account:

Checking

Savings

Bank Name:

Please Enter Your Routing Number:

Please Enter Account Number:

I understand and agree that this authorization will remain in effect until I provide written notification of its cancellation. I further understand that this authorization will cover any and all transactions related to the aforementioned program, including but not limited to the initial payment, recurring fees, and any additional charges that may be incurred.

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Your legal name

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Please Confirm full name and signature.

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Timestamp

Audit

October 6, 2025 10:04 am EST

ACH - Premium Promo Uploaded by Brian Warden - brian@1040taxbiz.com IP 96.72.237.110

October 6, 2025 10:04 am EST

Admin Admin - admin@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 204.156.181.61

November 18, 2025 5:49 pm EST

Lisa Martin - Lisa@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110

November 18, 2025 5:49 pm EST

Brian Warden - brian@1040taxbiz.com added by Brian Warden - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110