Automated Recurring Billing (ARB) Authorization (2lang)

This Automated Recurring Billing (ARB) Authorization form is used to authorize a specified payment amount on that card to be charged automatically per the set schedule of payments according to the active payment plan on file with the Court.

INSTRUCTIONS FOR FILING AUTOMATED RECURRING BILLING (ARB) AUTHORIZATION FORM 1) Type in all necessary information on the form. You must read and initial every statement on the first page, as well as complete the second page including the care information, billing address, phone number, and email. 2) If you enter information on the amounts or dates of payment that differ from your contract, the Court will re-issue a contract to coincide with your ARB request which will result in the addition of a $10.00 Contract Administration fee. 3) Save the form and file it with the Court. 4) To file with the Court, you must submit the completed form to the Court by email as an attachment (Word or PDF attachments only), by fax, by mail, or in person. 5) After the Court receives your form, it takes about 7‐10 working days for the Court to process your request. If there is a payment due on this case in that time, please make that payment manually to avoid any late payments. 6) If your mailing address has changed, please be sure to include that information with your request or contact the Court.

I,

and

My credit/debit card ending in

will be used by Scottsdale City Court to pay on my case in the amount of $

per my contract. The funds will be authorized on the

I understand the following: