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I hereby authorize OptiOpto<\/span>, to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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checking account<\/span><\/label><\/span>savings account<\/span><\/label><\/span>one-time ACH payment<\/span><\/label><\/span>automatic monthly ACH payment<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n

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BANK INFORMATION\n\t\t<\/h2>\n\t<\/div>\n<\/div>\n
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Depository (Bank) Name<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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Address<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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Street Address<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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Address Line 2<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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City<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n\t
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State \/ Province \/ Region<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n\t
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Checking \/ Savings Account No.<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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Date for funds to be withdrawn<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n\t
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Effective Start Date<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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This authority is to remain in effect until OptiOpto has received written notification of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date, from the undersigned of its termination. For ACH debits to my checking\/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that OptiOpto may at its discretion attempt to process the charge again within 10 days, and agree to an additional $30.00 charge for each attempt returned NSF. The additional NSF charge will be initiated as a separate transaction from the authorized recurring payment. I, the undersigned had read and agree to all program guidelines.\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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CONTACT INFORMATION\n\t\t<\/h2>\n\t<\/div>\n<\/div>\n
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Location Name<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n\t
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OptiOpto Acct #<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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Contact Name<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n\t
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Email Address<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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Telephone #<\/label><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n
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If you agree to these terms please sign here<\/label><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"col_12\">\n\t<label>DATE<\/label><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-952\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"submitbtn\">\n\t<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d9f1421 elementor-widget elementor-widget-text-editor\" data-id=\"d9f1421\" data-element_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\tBelow you can find the Terms & Conditions for OptiOpto<\/span>.<\/p>1. OptiOpto<\/span> is authorized to act as a purchasing agent for Member. Member will use its personal OptiOpto<\/span> “ship-to” numbers to order directly from the vendor, with supplies to be shipped directly to Member’s office. Member will arrange all shipping and handling directly with the vendor, and OptiOpto<\/span> will not serve any role whatsoever with respect to shipping and handling. Any dispute, which the client may have with any bill from OptiOpto<\/span> in regards to vendor charges must be reported to our accounting department within 30 days from the billing date.<\/p>2. Except as otherwise provided herein, OptiOpto<\/span> agrees to pay vendors for any products ordered on a OptiOpto<\/span> \u201cship-to\u201d number by a OptiOpto<\/span> Member in good standing. Member agrees that if its account has an unpaid balance after the last day of the month that billing is received, OptiOpto<\/span> reserves the right to place the Member\u2019s account on credit hold and no further shipments will be made to Member until such unpaid balance is paid in full. To reopen the account, an advance fee or open letter of credit may be required from Member.<\/p>3. OptiOpto<\/span> will bill Member on or about the tenth (10th) day of each month for all purchases made by such Member for the previous month. All discounts are based on cash\/check payments. All other payment methods will be subject to a 2.75% reduction in total discount given. To obtain published discounts, Member\u2019s payment to OptiOpto<\/span> must be postmarked net 10 days from the statement date. Failure to submit full payment by such date will result in the loss of the available discount, and Member will be required to pay the full list price for all such merchandise relating to the late payment. Finance charges will accrue on all outstanding balances at a rate of 1.50% monthly. Your account will be charged a $30.00 for NSF checks or declined payment via credit card.<\/p>4. For merchandise purchased as a Member of OptiOpto<\/span>, OptiOpto<\/span> agrees to credit Member for any returned merchandise approved by vendor; OptiOpto<\/span> shall apply such credit in the same billing period that the vendor issues such credit to OptiOpto<\/span>. Member understands that partial payment to OptiOpto<\/span> in expectation of further credits will result in loss of that month\u2019s discount. OptiOpto<\/span> does not accept responsibility for unauthorized or improperly returned items.<\/p>5. In the event OptiOpto<\/span> refers this account to a collection agency or attorney for collection of any unpaid amounts, Member agrees to pay all costs of collection including court costs and reasonable attorneys\u2019 fees.<\/p>6. In the event of a change of ownership of Member, Member is required to deliver to OptiOpto<\/span> prior written notice of such change, at which time the existing account of Member will be closed and new ownership must apply for membership. Failure to comply with this provision will result in Member being responsible for any purchases made through the account after the effective date of the change of ownership.<\/p>7. To the extent Member participates in OptiOpto<\/span> Medical\/Surgical Products purchasing programs, then the Member is hereby notified that, except as otherwise provided on the attached Administrative Fee Exception Schedule, the fees paid by vendors to OptiOpto<\/span> are as described in the applicable participation agreement signed by the Member. OptiOpto<\/span> will notify Member of any changes to the Administrative Fee Exception Schedule. On an annual basis, OptiOpto<\/span> shall provide Customer written notice of the amount of administrative fees which OptiOpto<\/span> has received from vendors with respect to purchases made by or on behalf of Customer.<\/p>8. In certain cases, OptiOpto<\/span> acts as a purchasing agent for Members who furnish goods or services for which payment may be made in whole or in part by Medicare, Medicaid or other Federal health care programs. In this event, our GPO services, as well as any rebates or discounts provided by a vendor, are intended to comply with the Anti-Kickback statute and regulations. Thus, a vendor such asJohnson & Johnson Vision Care (JJVC) will pay OptiOpto<\/span> administrative fees for its consolidated billing and other support services of up to 3% and in JJVC’s case that amount is 1.5% based on the purchase price of the products provided by JJVC.<\/p>Each year, OptiOpto<\/span> will disclose in writing to its Members the amount received from a vendor like JJVC with respect to purchases made or on behalf on each Member. In addition, if OptiOpto<\/span> negotiates a discount or rebate on a Member’s behalf, we will report such discount or rebate on each invoice or statement notifying the Member that the Member will have an obligation to report such discount or rebate and provide additional information upon request of the Secretary of HHS or a state agency. Other than OptiOpto<\/span> acting as a purchasing agent for its Members, neither OptiOpto<\/span> nor OptiOpto <\/span>Group has any other relationship with its Members.<\/p>Each principal owner of a Member, which is a proprietorship, partnership, limited liability company or corporation, shall similarly abide by the terms and conditions of this Agreement and, by signing below, shall personally guarantee payment of all charges billed by OptiOpto<\/span>. Upon signing this application, the undersigned authorizes OptiOpto<\/span> to obtain a written or oral report from any credit-reporting agency and supplier reference to enable OptiOpto<\/span> to have access to any and all necessary information needed to process this application. The undersigned, as the principal owner(s) and\/or executive officer(s) of Member, hereby personally guarantees all of Member\u2019s obligations hereunder as set forth in this agreement. ADMINISTRATIVE FEE EXCEPTION SCHEDULE (Updated as of August 10, 2010)<\/p>9. Member Transparency Notification: OptiOpto<\/span> (The Alliance & Combine Buying Groups & Much More) is a purchasing alliance designed to help independent purchasers compete with larger entities who have significant purchasing power. OptiOpto<\/span> is affiliated with the OptiOpto<\/span>, which began in 1996 and is now the leading global association of Independent Opticians and Optometrists, delivering collective buying power, operational best practices, strategic solutions and other services to more than 8000 Members across Europe, Latin America and North America.<\/p>OptiOpto <\/span>does not require Members to pay any fees for their membership. OptiOpto<\/span> supports its Members by providing a number of services, including vendor contract negotiations, negotiations for promotions and discounts to help its members, consolidated billing services to help reduce the number of invoices needing to be processed, and the creation of additional member service offerings such as continuing education\/training, practice marketing, consulting and more. OptiOpto<\/span> is committed to making running a practice easier for its Members while at the same time seeking to drive more profit to the Member practices’ bottom lines. All of these efforts require funding and OptiOpto <\/span>funds this in different ways depending on the vendor.<\/p>In certain cases, OptiOpto<\/span> acts as a purchasing agent for Members who furnish goods or services for which payment may be made in whole or in part by Medicare, Medicaid or other Federal health care programs. In this event, our GPO services, as well as any rebates or discounts provided by a vendor, are intended to comply with the Anti-Kickback statute and regulations. Thus, a vendor such as Johnson & Johnson Vision Care (JJVC) will pay OptiOpto<\/span> administrative fees for its consolidated billing and other support services of up to 3% and in JJVC’s case that amount is 1.5% based on the purchase price of the products provided by JJVC. Each year, OptiOpto<\/span> will disclose in writing to its Members the amount received from a vendor like JJVC with respect to purchases made or on behalf on each Member. In addition, if OptiOpto<\/span> negotiates a discount or rebate on a Member’s behalf, we will report such discount or rebate on each invoice or statement notifying the Member that the Member will have an obligation to report such discount or rebate and provide additional information upon request of the Secretary of HHS or a state agency. Other than OptiOpto<\/span> acting as a purchasing agent for its Members, neither OptiOpto<\/span> nor OptiOpto<\/span> Group has any other relationship with its Members. OptiOpto<\/span> funding mechanisms are utilized with the positive intent of providing the best value possible to OptiOpto<\/span> Members while avoiding having to require Members to pay fees just to be Members.<\/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\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"Sign Up for Automatic ACH Payments Now Sign up for automatic ACH payments now and discover how the ACH Network can streamline your payment process. ACH Payment Information The ACH Network is a highly reliable and efficient nationwide batch-oriented electronic funds transfer system governed by the NACHA OPERATING RULES, which provide for the interbank clearing […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7065","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/pages\/7065","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/comments?post=7065"}],"version-history":[{"count":40,"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/pages\/7065\/revisions"}],"predecessor-version":[{"id":7119,"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/pages\/7065\/revisions\/7119"}],"wp:attachment":[{"href":"https:\/\/hashtitude.com\/cecop\/wp-json\/wp\/v2\/media?parent=7065"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}