Daniels

AutoPay

Employee#

Pin#

Pin # is Required

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Store ID

Store ID is Required

Customer ID

Customer ID is Required

Lookup

Account Information

Account #:

,

Phone:
Authorized Cell:
Authorized Email:

Recurring Payment Settings

Status

Payment Amount

Each Month on this day

Card Type

Ending in

Notification Email

Notification Cell Phone

Receipt Language

Last Auto Payment taken

Next Auto Payment will be

To set up your recurring monthly payment, or to modify your existing recurring payment, you may make selections below to configure how you wish to pay and how you wish to be notified about upcoming payments and receipts for those payments once they have been made.

1. New Selections

Enter your new monthly recurring payment choices:

Payment Amount

Required

Payment Day of Month

Required

Next Payment Date

Required

2. Customer Notice

During the sign-up process, your customer will receive an email or a text with an important notice. If the customer does not receive this email or text, you must provide important documents to the customer (see step #6)

3. Payment Method - Card on File

To use an existing card on file for your payments, select the card here.

Debit Card
Name on Card

Last 4

Expires on

Please Select a Card on File before clicking this Payment button.

4. Payment Method - New Card

You may make recurring payments by entering a Debit Card here. Enter the Name And Address as it appears on the Debit Card statement. Please help us post this accurately by giving us the correct billing address.

Name of Card Holder

Name Is Required

Street

Street Is Required

City

City Is Required

State

State Is Required

Zip

Zip Code Is Required

Enter Debit Card Number

Required

Expiration Date

CVV

Required

What's This?

Error with card: CannotMapToAnyType

5. Receipt Options

Choose one or more options below for where to deliver your receipts, and notifications about upcoming payments.

Cell Phone #

Phone Number is Required

Text my receipt to this cell phone

Email Address

Email is invalid

Email my receipt to this email address

Receipt Language

Required

Required: Choose one or more options above

6. Authorization - Reg-E (Required)

By completing this form you are authorizing Daniel's Jewelers to take a recurring payment each month on the day listed above.To acknowledge and accept this recurring payment plan, you must have a unique code sent to your 'Receipt Phone' or 'Receipt Email' and then enter the code here to complete this process.

Code 2 has been sent to your cell phone.

Payment Authorization Number:

Associate Instructions
1. if your customer is in the store and received an authorization code or if you are speaking to your customer over the phone, have them read the authorization code to you, enter it above and click CHECK button to continue with the final step 7-Finish.
2. If your customer is in the store and did not receive an authorization code, you must click on the link below, open an important customer document, print it, complete the open spaces, give all three pages to the customer and then click in the box below and to continue with the final step 7-Finish.
DO NOT CONTINUE WITHOUT ENTERING IN A VALID PERSONAL AUTHORIZATION CODE *OR* COMPLETING AND PROVIDING THE CUSTOMER THE DOCUMENT BELOW

Automated Scheduled Payment Agreement

I certify that I completed and gave all three pages of the Fill-in Esign and Automated Scheduled Payment Agreement to my Customer.

7. Finish

Once you have entered correct codes in the authorization sections above, you will be able to accept your new settings.

An error occurred saving your changes

Account Information

Recurring Payment Settings

1. New Selections

2. Customer Notice

3. Payment Method - Card on File

4. Payment Method - New Card

5. Receipt Options

6. Authorization - e-Signing (Required)

6. Authorization - Reg-E (Required)

7. Finish