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Autopay Forms

Please download and complete the authorization form for the

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

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Email completed forms and requested documentation to:  accounting@gsrx.com

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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. 

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