Electronic Fund Transfer (EFT) Authorization

The Purchaser hereby authorizes Kwik Trip, Inc. to originate entries transferring funds from ("debit") or to ("credit") Purchaser's deposit account.


Please note that Kwik Trip requires the bank account belong to the non-profit organization and is not a personal bank account.

The amount of debit entries to Purchaser's account will be based on monies due to Kwik Trip, Inc. All payments are due upon shipment of the order (the next banking day).

Any notice required or permitted under this agreement will be properly given via U.S. Mail, Fax, or Email.

Notice of termination shall not affect entries originated prior to receipt of notice of termination of this agreement and will not be effective until fifteen (15) days after properly given. Kwik Trip, Inc. may terminate this agreement at any time without notice.

Kwik Trip, Inc, will use its best efforts to ensure that debit entries to Purchaser's account, originated by Kwik Trip, Inc., are in the correct amounts. In no event will Kwik Trip, Inc. be liable for any incidental or consequential damages associated with an incorrect entry process by Purchaser's financial instutution and will be responsible only for the refund of any overcharge when verified by Kwik Trip, Inc. as such.

Purchaser agrees to keep sufficient funds in the account to cover debit entries originated by Kwik Trip, Inc.

Once your enrollment form is received we will set up an account for you. You will be contacted and given your user id and password and may place an order immediately.

Billing Information
Shipping Information
If your shipping address for your cards will be different than your billing address, please specify it here.
We cannot ship to a P.O. Box. Please enter a physical address.
Organization Coordinator
EFT Information
Enter the following information about the bank account we will draw funds from.:
Marketing Data