Client Agreement | National Acceptance Company

Client Name
Client Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fees
Stop Payment Fee*
Line Item 5
EFT Transaction collection fee*
Line Item 6, 1
CC Transaction collection fee*
Line Item 6, 2
Check/Money Order Transaction collection fee*
Line Item 6, 3
Minimum fee per item*
Line Item 6, 4
Termination & Administrative Charges
Cancelled per-account charge*
Line Item 10.2
Disputed Credit Card Transaction Fee*
Line Item 11, 1
Fee for Cancellation prior to contraction completion*
Line Item 11, 2
EFT Refund Service Fee*
Line Item 11, 3
Fee for Accounts paid-in-full at facility*
Line Item 11, 4
Wire Transfer Fee-Electronic*
Line Item 11, 5
Wire Transfer Fee-Paper Check*
Line Item 11, 6
Annual PCI Fee*
Line Item 11, 7
Client Representative*
First Last
Client Email*

Fees