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Sample - WEB authorization for electronic checks

Transaction Authorization: By clicking the "authorization" button below, I confirm that I am the owner of the account identified by the numbers entered above and authorize this merchant to convert my account information entered above into an electronic debit to, my account for the amount of this transaction. In the event that my electronic debit is returned unpaid, I agree that a returned item fee also may be debited from my account electronically. The amount of the fee will be determined by the state where my billing address is located. Further, by submitting a transaction, I expressly authorize this merchant to obtain a report of my check-writing history to prevent fraud and for other authentication purposes.

Sample of confirmation email to consumer

Confirmation Notice. Thank you for your order Please print a copy of this receipt for your records.

Your transaction at www.merchant.com was authorized on (date). For your records, the item(s) purchased include(s):

1	Item	xxxx
1	Products	xxxx
	Total	xxxx

and will be shipped to:

Any Consumer

12345 Any Street

Their Town, State, Zip

Payment for this transaction will be processed electronically, debiting the (Total) amount stated above from the account of, (Name of Consumer) , on, or soon after, one business day from the date you authorized this transaction. You gave your authorization on (date) to electronically debit your account when you clicked on the "I Authorize This Transaction" button. Make sure you void the check submitted for this transaction, so as to avoid re-presentment of the same check elsewhere.

Please be advised that this transaction should appear on your next bank statement in the electronic debit section (where you normally see your ATM transactions). The transaction information should include the merchant’s name, the posting date, the check number you entered at the time of the transaction, and the amount of the transaction as stated above.

If you have any need to contact us regarding your transaction (including to correct any erroneous information or to request a refund, you may do so by calling us at, (800) 555-1234, or e-mailing us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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