Autopay Forms

Please download and complete the authorization form for the

auto-payment method you prefer (EFT Bank Draft or Credit Card).

Email completed forms and requested documentation to:  accounting@gs-rx.com

NOTE:  All autopayment accounts will be drafted on the 10th of the month

for the previous month's statement balance. Auto-payment agreements require a

minimum of five (5) day's written notice prior to the withdrawal date to cancel.