Authorization Form
To process your monthly payments, we need you to complete this form as a means of authorization. Please provide the following contact information:
Full Name
First Name
Last Name
Work Phone
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Area Code
Phone Number
Home Phone
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Area Code
Phone Number
E-mail
Billing Information
Payment Authorization
Click the button below to indicate your authorization to deduct 12 monthly payment from the above listed credit card approx. 30 days after hitch ships on the 15th or 30 of the month. Note: MI, WA and KY residents charged applicable sales tax plus down payment. Additional shipping costs for out of the U.S. are also applied to the first payment. Failure to honor this payment agreement with Hensley Mfg., Inc. constitutes default of the agreement. Hensley Mfg., Inc. reserves the right to call the entire balance of the debt due at the time of default. Default cancels the money back guarantee. Default suspends the lifetime warranty until the entire debt is paid in full to Hensley Mfg., Inc. In the event that your installment payment, check or credit card is declined, we will send you a statement (by 1st class mail to the address you have provided us) and/or call you regarding the remaining outstanding balance. We reserve the right to charge you 1 ½ % interest per month on any statement(s) not paid by the stated due date. A $5.00 late fee/statement fee will also be charged to your account each and every month until the account is paid in full. Finally, should the services of a collection/recovery/attorney or agency be deemed necessary to secure payment on the account, any and all associated charges will be your responsibility, and litigated in a court of law in and for Davison, Michigan, our headquarters location.
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Signature
By selecting this button, I understand that I am sending my digital authorization to process this form.
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