{"id":10598,"date":"2026-01-26T01:26:57","date_gmt":"2026-01-26T01:26:57","guid":{"rendered":"https:\/\/cacheinfosys.com\/?page_id=10598"},"modified":"2026-01-26T02:28:31","modified_gmt":"2026-01-26T02:28:31","slug":"auto-pay-authorization-form","status":"publish","type":"page","link":"https:\/\/cacheinfosys.com\/it\/auto-pay-authorization-form\/","title":{"rendered":"Auto Pay Authorization Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"10598\" class=\"elementor elementor-10598\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8b5422b e-flex e-con-boxed e-con e-parent\" data-id=\"8b5422b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0d6cda0 elementor-widget__width-inherit elementor-widget-laptop__width-initial elementor-widget elementor-widget-heading\" data-id=\"0d6cda0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Auto Pay Authorization Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ff5ad75 elementor-widget elementor-widget-text-editor\" data-id=\"ff5ad75\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Authorize recurring payments and select your preferred payment method securely.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f3f4f69 e-con-full e-flex e-con e-parent\" data-id=\"f3f4f69\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-26d25cc elementor-widget-mobile__width-inherit ha-has-bg-overlay elementor-widget elementor-widget-shortcode\" data-id=\"26d25cc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">  <div class=\"apa-wrap\">\n    <div class=\"apa-card\">\n      <div class=\"apa-header\">\n        <!-- Add header content if you want -->\n      <\/div>\n\n      \n            <form class=\"apa-form\" method=\"post\" action=\"\">\n        <input type=\"hidden\" id=\"apa_nonce\" name=\"apa_nonce\" value=\"f686118b1e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/it\/wp-json\/wp\/v2\/pages\/10598\" \/>        <input type=\"hidden\" name=\"apa_action\" value=\"submit\" \/>\n        <input type=\"hidden\" name=\"apa_signature_data\" id=\"apa_signature_data\" value=\"\" \/>\n\n        <!-- Section: Contact Information -->\n        <div class=\"apa-section\">\n          <div class=\"apa-section-title\">Contact Information<\/div>\n          <div class=\"apa-section-help\">Please provide your contact info.<\/div>\n\n          <!-- Row 1 -->\n          <div class=\"apa-field\">\n            <label class=\"apa-label\">Full Name <span class=\"apa-req\">*<\/span><\/label>\n            <div class=\"apa-grid-2\">\n              <div>\n                <input class=\"apa-input\" type=\"text\" name=\"apa_first_name\" placeholder=\"First Name\" required>\n              <\/div>\n              <div>\n                <input class=\"apa-input\" type=\"text\" name=\"apa_last_name\" placeholder=\"Last Name\" required>\n              <\/div>\n            <\/div>\n          <\/div>\n\n          <!-- Row 2 -->\n          <div class=\"apa-field\">\n            <label class=\"apa-label\">Company Name<\/label>\n            <input class=\"apa-input\" type=\"text\" name=\"apa_company_name\" placeholder=\"\">\n          <\/div>\n\n          <!-- Row 3 -->\n          <div class=\"apa-field\">\n            <div class=\"apa-grid-2\">\n              <div>\n                <label class=\"apa-label\">Phone Number <span class=\"apa-req\">*<\/span><\/label>\n                <input class=\"apa-input\" type=\"tel\" name=\"apa_phone\" placeholder=\"(000) 000-0000\" required\n                       pattern=\"^\\(?\\d{3}\\)?[ .-]?\\d{3}[ .-]?\\d{4}$\"\n                       title=\"Please enter a valid phone number.\">\n                <div class=\"apa-hint\">Please enter a valid phone number.<\/div>\n              <\/div>\n              <div>\n                <label class=\"apa-label\">Email Address <span class=\"apa-req\">*<\/span><\/label>\n                <input class=\"apa-input\" type=\"email\" name=\"apa_email\" placeholder=\"example@example.com\" required>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/div>\n\n        <!-- Payment Method -->\n        <div class=\"apa-section\">\n          <div class=\"apa-field\">\n            <label class=\"apa-label\">Select your preferred payment method <span class=\"apa-req\">*<\/span><\/label>\n            <div class=\"apa-radio-group\" role=\"radiogroup\" aria-label=\"Preferred payment method\">\n              <label class=\"apa-radio\">\n                <input type=\"radio\" name=\"apa_payment_method\" value=\"Credit\/Debit Card\" required id=\"payment_credit\">\n                <span>Credit\/Debit Card<\/span>\n              <\/label>\n              <label class=\"apa-radio\">\n                <input type=\"radio\" name=\"apa_payment_method\" value=\"ACH\/Bank Transfer\" required id=\"payment_ach\">\n                <span>ACH\/Bank Transfer<\/span>\n              <\/label>\n            <\/div>\n          <\/div>\n\n          <!-- Credit Card Section -->\n          <div class=\"apa-payment-section\" id=\"credit_card_section\" style=\"display:none;\">\n            <div class=\"apa-divider-title\">Credit Card Information (information will be collected securely)<\/div>\n\n            <div class=\"apa-field\">\n              <label class=\"apa-label\">Cardholder Name <span class=\"apa-req\">*<\/span><\/label>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_cc_cardholder_name\" placeholder=\"Name on Card\">\n            <\/div>\n\n            <div class=\"apa-field\">\n              <label class=\"apa-label\">Card Business Name<\/label>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_cc_business_name\" placeholder=\"Optional\">\n            <\/div>\n\n            <div class=\"apa-field\">\n              <div class=\"apa-grid-2\">\n                <div>\n                  <label class=\"apa-label\">CC Number <span class=\"apa-req\">*<\/span><\/label>\n                  <input class=\"apa-input\" type=\"text\" name=\"apa_cc_number\" placeholder=\"0000-0000-0000-0000\" id=\"cc_number\">\n                  <div class=\"apa-hint\">Please add respective dashes<\/div>\n                <\/div>\n                <div>\n                  <label class=\"apa-label\">Card Type <span class=\"apa-req\">*<\/span><\/label>\n                  <select class=\"apa-input\" name=\"apa_cc_type\">\n                    <option value=\"\">Please Select<\/option>\n                    <option value=\"American Express\">American Express<\/option>\n                    <option value=\"Discover\">Discover<\/option>\n                    <option value=\"Mastercard\">Mastercard<\/option>\n                    <option value=\"Visa\">Visa<\/option>\n                  <\/select>\n                <\/div>\n              <\/div>\n            <\/div>\n\n            <div class=\"apa-field\">\n              <label class=\"apa-label\">Billing Address <span class=\"apa-req\">*<\/span><\/label>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_cc_street_address\" placeholder=\"Street Address\" style=\"margin-bottom:12px;\">\n              <input class=\"apa-input\" type=\"text\" name=\"apa_cc_street_address_2\" placeholder=\"Street Address Line 2\" style=\"margin-bottom:12px;\">\n              <div class=\"apa-grid-2\" style=\"margin-bottom:12px;\">\n                <input class=\"apa-input\" type=\"text\" name=\"apa_cc_city\" placeholder=\"City\">\n                <input class=\"apa-input\" type=\"text\" name=\"apa_cc_state\" placeholder=\"State \/ Province\">\n              <\/div>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_cc_postal_code\" placeholder=\"Postal \/ Zip Code\">\n            <\/div>\n          <\/div>\n\n          <!-- ACH\/Bank Section -->\n          <div class=\"apa-payment-section\" id=\"ach_section\" style=\"display:none;\">\n            <div class=\"apa-divider-title\">ACH\/Bank Information (will be collected securely)<\/div>\n\n            <div class=\"apa-field\">\n              <label class=\"apa-label\">Bank Account Name (Name on Account) <span class=\"apa-req\">*<\/span><\/label>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_ach_account_name\" placeholder=\"Account Name\">\n            <\/div>\n\n            <div class=\"apa-field\">\n              <label class=\"apa-label\">Bank Name <span class=\"apa-req\">*<\/span><\/label>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_ach_bank_name\" placeholder=\"Bank Name\">\n            <\/div>\n\n            <div class=\"apa-field\">\n              <label class=\"apa-label\">Account Type <span class=\"apa-req\">*<\/span><\/label>\n              <select class=\"apa-input\" name=\"apa_ach_account_type\">\n                <option value=\"\">Please Select<\/option>\n                <option value=\"Checking\">Checking<\/option>\n                <option value=\"Savings\">Savings<\/option>\n                <option value=\"Business Checking\">Business Checking<\/option>\n                <option value=\"Business Savings\">Business Savings<\/option>\n              <\/select>\n            <\/div>\n\n            <div class=\"apa-field\">\n              <div class=\"apa-grid-2\">\n                <div>\n                  <label class=\"apa-label\">Routing Number \/ ABA <span class=\"apa-req\">*<\/span><\/label>\n                  <input class=\"apa-input\" type=\"text\" name=\"apa_ach_routing_number\" placeholder=\"e.g., 123456789\" pattern=\"[0-9]{9}\" maxlength=\"9\">\n                <\/div>\n                <div>\n                  <label class=\"apa-label\">Account Number <span class=\"apa-req\">*<\/span><\/label>\n                  <input class=\"apa-input\" type=\"text\" name=\"apa_ach_account_number\" placeholder=\"e.g., 23\">\n                <\/div>\n              <\/div>\n            <\/div>\n\n            <div class=\"apa-field\">\n              <label class=\"apa-label\">Account Address <span class=\"apa-req\">*<\/span><\/label>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_ach_street_address\" placeholder=\"Street Address\" style=\"margin-bottom:12px;\">\n              <input class=\"apa-input\" type=\"text\" name=\"apa_ach_street_address_2\" placeholder=\"Street Address Line 2\" style=\"margin-bottom:12px;\">\n              <div class=\"apa-grid-2\" style=\"margin-bottom:12px;\">\n                <input class=\"apa-input\" type=\"text\" name=\"apa_ach_city\" placeholder=\"City\">\n                <input class=\"apa-input\" type=\"text\" name=\"apa_ach_state\" placeholder=\"State \/ Province\">\n              <\/div>\n              <input class=\"apa-input\" type=\"text\" name=\"apa_ach_postal_code\" placeholder=\"Postal \/ Zip Code\">\n            <\/div>\n          <\/div>\n\n          <div class=\"apa-schedule\">\n            <div class=\"apa-schedule-main\">\n              Automatic payments are to be processed on the 1st day of each month using the submitted payment method.\n            <\/div>\n            <div class=\"apa-schedule-sub\">\n              You can also add your automatic payment information via the Cache Portal.\n            <\/div>\n          <\/div>\n        <\/div>\n\n        <!-- Authorization + Signature -->\n        <div class=\"apa-section\">\n          <div class=\"apa-field\">\n            <label class=\"apa-checkbox\">\n              <input type=\"checkbox\" name=\"apa_authorize_checkbox\" value=\"1\" required>\n              <span>I authorize recurring payments as described above.<\/span>\n              <span class=\"apa-req\">*<\/span>\n            <\/label>\n          <\/div>\n\n          <div class=\"apa-field\">\n            <label class=\"apa-label\">Signature (required) <span class=\"apa-req\">*<\/span><\/label>\n\n            <div class=\"apa-signature\">\n              <canvas id=\"apa_signature_canvas\" class=\"apa-signature-canvas\" width=\"900\" height=\"240\"><\/canvas>\n              <div class=\"apa-signature-overlay\" id=\"apa_signature_overlay\">Sign Here<\/div>\n\n              <div class=\"apa-signature-actions\">\n                <button type=\"button\" class=\"apa-btn-secondary\" id=\"apa_clear_signature\">Clear<\/button>\n                <input class=\"apa-input apa-signature-name\" type=\"text\" name=\"apa_signature_name\"\n                       placeholder=\"Type your full name (optional)\">\n              <\/div>\n              <div class=\"apa-hint\">Draw your signature above. It is required to submit.<\/div>\n            <\/div>\n          <\/div>\n        <\/div>\n\n        <div class=\"apa-actions\">\n          <button class=\"apa-btn\" type=\"submit\">Submit Billing Information<\/button>\n        <\/div>\n      <\/form>\n          <\/div>\n  <\/div>\n  <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Auto Pay Authorization Form Authorize recurring payments and select your preferred payment method securely.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-10598","page","type-page","status-publish","hentry"],"acf":[],"_hostinger_reach_plugin_has_subscription_block":false,"_hostinger_reach_plugin_is_elementor":false,"_links":{"self":[{"href":"https:\/\/cacheinfosys.com\/it\/wp-json\/wp\/v2\/pages\/10598","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cacheinfosys.com\/it\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cacheinfosys.com\/it\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cacheinfosys.com\/it\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cacheinfosys.com\/it\/wp-json\/wp\/v2\/comments?post=10598"}],"version-history":[{"count":0,"href":"https:\/\/cacheinfosys.com\/it\/wp-json\/wp\/v2\/pages\/10598\/revisions"}],"wp:attachment":[{"href":"https:\/\/cacheinfosys.com\/it\/wp-json\/wp\/v2\/media?parent=10598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}