-ACH Submission-

As an authorized signor on the banking account presented below and by completing and signing this form you give Lost My Pet permission to debit or credit, as needed, your banking account. 

This authorization is to remain in full force and effect until Lost My Pet has received written notification from the authorized signor of its termination. I acknowledge that a Non‐Sufficient Funds (NSF) fee of $35 may be charged by Lost My Pet to the Company for all returned payments.


I authorize Lost My Pet to debit and or credit our banking account on a recurring basis, for products and services received from Lost My Pet and its affiliated companies.

I have the authority to and agree to grant the use of this payment method for purchases or settlements from the Lost My Pet platform.