Administrative Processing Fee Authorization

Client Name *

Date *

I authorize ($175) *

A2 Assemble Solutions to charge my payment method in the amount of: $175.00 Administrative Processing Fee

This fee covers administrative services, client onboarding, file setup, document review, compliance procedures, and related support services requested by the client.

I acknowledge that:

I have requested these services.
I am the authorized user of the payment method provided.
I understand the amount being charged.
I voluntarily authorize this transaction.
I understand that this authorization may be used to verify my approval of the charge.

Billing Concerns *

I agree to contact A2 Assemble Solutions directly regarding any questions or concerns before initiating a dispute or chargeback with my financial institution.

Electronic Signature

Client Signature *

Clear

Client Signature Date *