Application for Ad Credit Line and Autopay Authorization
I hereby authorize payment by the financial institution named below for the Payment Amount and Processing Fee stated above and warrant all information given is true. I further understand that monthly transactions are non-refundable and we not dispute payments with the check or card issuing bank. By submitting this form you agree to the terms and services agreement listed below.
Name on Account
Address Line 2
State / Province / Region
ZIP / Postal Code
Antigua and Barbuda
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Congo, Democratic Republic of the
Congo, Republic of the
French Southern Territories
Heard and McDonald Islands
Isle of Man
Lao People's Democratic Republic
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Svalbard and Jan Mayen Islands
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
US Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Are you requesting an Ad Credit Line Increase?
Yes, increase my ad credit line.
Ad Spend Amount Requested:
Please enter a number from
Upload voided check or use credit card on file?
Yes, I'll upload a voided check.
No, I'll enter my bank account and routing numbers
Please use my credit card on file
Upload Voided Check
Bank Routing #
Bank Account #
Terms and Service Agreement
1.0 Services Rendered
Ad Credit Line and Autopay Authorization
energyhill will provide a credit amount of $2,500 with Google (+3% processing fee). If no amount is entered this form will be used for autopay authorization only. Additional amount above $2,500 will need to be entered below and authorized by energyhill leadership. In order to qualify for this credit the account must be in good standing (all invoices paid), and an e-Check payment will be processed in accordance with the signed e-Check authorization form. If e-check is not going to be used a valid credit card must be on file. Please make sure funds are available for this deduction.
2.0 Mutual Cooperation We agree to use our best efforts to fulfill and exceed your expectation on the deliverables listed above. You agree to aid us in doing so by making available to us needed information pertaining to your account.
3.0 Charges for Services Performed Requests above and beyond those listed in the budget may be considered out-of-scope and an amendment to the budget will be recommended. Projects that go dormant for longer than 10 days will incur a 5% fee to resume work at the discretion of energyhill.
4.0 Terms of Payment
4.1 BILLING SCHEDULE
We're sure you understand how important it is as a small business that you pay the invoices that we send you promptly. We're also sure you'll want to maintain a positive working relationship and keep the project moving forward, so you agree to stick tight to the following payment schedule.
energyhill will invoice the client the credit amount listed at point of this signed contract agreement which will act as the deposit. The client will supply energyhill with all necessary purchase order numbers and other internal information required for invoice processing before the close of the month of work (if applicable).
4.2 CLIENT AGREEMENT TO PAY
You agree to pay our initial (1st) invoice upon receipt which will act as a deposit for the project. Every invoice after that will have 10 day payment terms. In the event payment is not made within 10 days, energyhill will charge a late payment fee of 5% per month on any overdue and unpaid balance not in dispute, to cover the manpower, interest, and other costs energyhill pays for carrying overdue invoices from the client. In addition, energyhill reserves the right to stop work until payment is received.
4.3 COLLECTION COSTS
In the event that we incur legal fees, costs and disbursements in an effort to collect our invoices, in addition to interest on the unpaid balance, you agree to reimburse us for these expenses.
5.0 CANCELLATION OF PLANS
You have the right to modify, reject, cancel or stop any and all plans or work in process. However, you agree to reimburse us for all costs and expenses we incurred prior to your change in instructions, and which relate to non-cancelable commitments, and to defend, indemnify and hold us harmless for any liability relating to such action. We agree to use our best efforts to minimize such costs and expenses. Quarterly work will be billed in its entirety for the quarter, and for months preceding up to 90 days, in which the request is made. Quarterly plans require 90 day notice in order for cancellation to commence. For example, if a request is made at the end of January, then the work for the first quarter is complete and work has already begun for April and will be billed in it's entirety. However, May and on would be in the planned time for cancellation.
6.0 Responsibilities of energyhill and client
6.1 energyhill'S RESPONSIBILITY FOR RELEASES We shall obtain releases, licenses, permits or other authorization to use testimonials, copyrighted materials, photographs, art work or any other property or rights belonging to third parties obtained by us for use in performing services for you (If applicable).
6.2 CLIENT'S RESPONSIBILITY FOR RELEASES
You guarantee that all elements of text, images, or other artwork you provide are either owned by your good selves, or that you have permission to use them. Then when your final payment has cleared, copyright will be automatically assigned as follows:
You'll own the visual elements that we create for this project. We'll give you source files and finished files and you should keep them somewhere safe as we're not required to keep a copy. You own all elements of text, images and data you provided, unless someone else owns them.
We'll own the unique combination of these elements that constitutes a complete design and we'll license that to you, exclusively and in perpetuity for this project only, unless we agree otherwise. We can provide a separate estimate for that.
6.3 CLIENT RESPONSIBILITY FOR ACCURACY
You shall be responsible for the accuracy, completeness and propriety of information concerning your products and services which you furnish to us verbally or in writing in connection with the performance of this Agreement.
energyhill acknowledges its responsibility, both during and after the term of its appointment, to use all reasonable efforts to preserve the confidentiality of any proprietary or confidential information or data developed by energyhill on behalf of the client or disclosed by the client to energyhill.
8.0 Term and Termination
8.1 Period of Agreement and Notice of Termination
This Agreement shall become effective as of Not yet submitted and shall continue until terminated by either party upon not less than 60 days' notice in writing given by either party to the other.
8.2 TERMINATION FOR CAUSE
Either party to this Agreement may terminate the Agreement if the other party defaults in the performance of any of its material duties and obligations and the default is not cured within thirty (30) days of the receipt of notice of said default, or if the default is not reasonably curable within said period of time, unless the defaulting party commences cure within said period of time and diligently proceeds to cure the default.
In addition, either party may immediately terminate this Agreement by giving written notice to the other party if the other party is insolvent or has a petition brought by or against it under the insolvency laws of any jurisdiction, if the other party makes an assignment for the benefit of creditors, if a trustee, or similar agent is appointed with respect to any property or business of the other party, or in the case of the Client, if the Client materially breaches its obligations to make payment pursuant to this Agreement.
8.3 PAYMENT FOR NON-CANCELABLE MATERIALS?
Any non-cancelable materials, services, etc., we have properly committed ourselves to purchase for your account, (either specifically or as part of a plan such as modules, photography and/or external services) shall be paid for by you, in accordance with the provisions of this Agreement. We agree to use our best efforts to minimize such liabilities immediately upon written notification from you. We will provide written proof, upon request of the client, that any such materials and services, are non cancelable.
8.4 MATERIALS UNPAID FOR
If upon termination there exist any materials furnished by us or any services performed by us for which you have not paid us in full, until such time as you have paid us in full you agree not to use any such materials, in whole or in part, or the product of such services.
8.5 TRANSFER OF MATERIALS
Upon termination of this agreement, provided that there is no outstanding indebtedness by the client to energyhill, energyhill shall transfer, assign and make available to client all property and materials in its possession or control belonging to the client. The client agrees to pay for all costs associated with the transfer of materials.
9.0 General Provisions
9.1 GOVERNING LAW
This Agreement shall be governed and construed in accordance with the laws of the Florida.
9.2 REPRESENTATIONS AND WARRANTIES
The parties each individually represent and warrant that each has full power and authority to enter into this Agreement and to perform all of their obligations hereunder without violating the legal or equitable rights of any third party.
9.3 ENTIRE AGREEMENT
Except as otherwise set forth or referred to in this Agreement, this Agreement constitutes the sole and entire Agreement and understanding between the parties hereto as to the subject matter hereof, and supersedes all prior discussions, agreements and understandings of every kind and nature between them as to such subject matter.
If any provision of this Agreement is held to be illegal, invalid, or unenforceable under any present or future law, then that provision will be fully severable. In such instance, this Agreement will be construed and enforced as if the illegal, invalid, or unenforceable provision had never comprised a part of this Agreement, and the remaining provisions of this Agreement will remain in full force and effect.
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5476 Land O Lakes Blvd.
Land O Lakes, FL, 34639
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