Monthly Billing Authorization Form

Paul Dion CPA

Opt-In to Monthly Billing & Gold Maintenance Plan

Yes, I want to assist in the conversion to Monthly Billings and take advantage of the 2 year fee freeze.

Please either fill out the form below or download the form and return it to us.

*My preparation fee charged monthly is:
Gold Maintenance Plan:
 
Total amount charged to me monthly is:
Please check one
This plan is ONLY available with Debit/Credit Card, or Direct Bank checking account debit.
(If you wish to have a direct debit from your bank account please fill in the First ACH form)
 
My card information is:
Your first monthly payment will be charged to your account on
Each subsequent monthly payment will be charged on the 1st day of each month. These charges will show up on your statement from Paul Dion CPA.

*Level Preparation fees are for like kind work. If you add a rental property, new business entity, or sell a property, etc., a fee to cover the 'new' work will be added to your normal prior year amount at the time of preparation.

This is an agreement from May 2016 through April 2017 for the preparation of your 2016 tax return to be completed in 2017. In addition, this agreement covers you for level preparation fees for 2016 and 2017 tax years based on your 2015 tax return fees. Your signature is authorization for this transaction.


MA: 508-853-3292 RI 401-490-3193 Toll Free: 800-754-3189 E-Fax 508-630-9008, 401-537-9182
E-Mail: paul@pauldioncpa.com                                        www.pauldioncpa.com