By typing AGREE in the below box I am providing my signature as authorization to Payment21&reg; to electronically debit my account for the amount I have entered. I also understand and expressly authorize the merchant, if my eCheck payment is dishonored or returned for any reason, to electronically debit my account for the amount of the eCheck payment plus an NSF fee not to exceed the state maximum legal limit. I will print or save this page for my records. I can call 1-888-770-0850 for 24/7 support with any questions regarding this payment transaction.