SCALE Healthcare Leadership Conference on October 18, 2023 at 8:00 AM-6:00 PM. Click here to register

Authorization Form

SCALE Community Standard Corporate
Membership Authorization for Direct Payment via ACH (ACH Debit)



    Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment.

    I (we) authorize SCALE Healthcare, LLC (“COMPANY”) to electronically debit my (our) account (and, if necessary, electronically credit my (our) account to correct erroneous debits) for SCALE Community membership fees as per the SCALE Community terms and conditions and as follows:

    at the depository financial institution named below (“DEPOSITORY”). I (we) agree that ACH transactions I (we) authorize comply with all applicable law.

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    I (we) understand that this authorization will remain in full force and effect until I (we) notify COMPANY in writing, that I (we) wish to revoke this authorization. I (we) understand that requires at least 30 days prior notice in order to cancel this authorization.

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