Electronic Funds Transfer
Sign Up Form
Form last updated: 12/11/2000
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Name(s):______________________________________________
Daytime Phone Number:______________________________________________
Email Address:______________________________________________
Simutronics Account Name:______________________________________________
Your name as it appears on the bank account:______________________________________________
Address as it appears on the bank account:______________________________________________
Checking account number:______________________________________________
Bank routing number:______________________________________________
Name of Financial Institution:______________________________________________

I (we) authorize my bank to make my Simutronics Corporation payments on my (our) behalf for the account indicated above for any balances owed, including monthly subscription fees and any other purchases or fees. I understand that I am in full control of my payment. If I choose to discontinue this arrangement, I will immediately notify Simutronics Corporation in writing.

Signature: __________________________________________ Date: _________________
Signature: __________________________________________ Date: _________________

Instructions

Thanks for signing up for Simutronics Games using Electronic Funds Transfer (often called EFT)! There are some important facts to know before completing this form.

1. You should call your financial institution to be sure that they allow EFT. Some institutions will use different routing numbers depending on whether a transaction is on a check/savings account or an EFT, so it is important that you get that information before setting up your account.

2. For your protection, Simutronics Corporation requires a voided check or savings account deposit slip on file to set up EFT billing. All you need to do is fill out the information below, print it, and mail it in with a voided check or savings account deposit slip, and we will start billing you every month.

If you want to speed up the process, you can fax this form and a copy of the voided check or savings account deposit slip to us at 314-395-2582 before you mail it.

3. There is a small fee to use this billing method. Simutronics will charge an additional $2.00 to each monthly billing for EFT transactions.

4. As with any check, when your EFT is returned for insufficient funds, a $15.00 processing fee will be added to the amount due.

Print and mail this page (or a handwritten copy) along with a voided check or savings account deposit slip to: