I authorize Novus Medical Group, Inc. a Florida company to deposit the bank account or credit card
indicated in this web form 
for the noted amount on the schedule indicated. This payment is commissions
owed for representing Novus 
health plan services. Once monthly commissions exceed the standard $25.00
transaction fee. If not I elect to receive funds 
for my commission with a company check written and sent in
the US Mail on the first of every month.  


I understand that this authorization will remain in effect until the schedule end date, or until I cancel it in writing,
which ever comes first, and I agree to notify the business in writing of any changes in my account information or
termination of this authorization at least 15 days prior to the next billing date. 
If the above noted payment date
falls on a weekend or holiday, I understand that the payment may be executed on the next business day. Subscriber

can only sign up in states where Novus MedPlan is licensed. 


In the case of an ACH Transaction being rejected for any reason I understand that the business may at its discretion
attempt to process the deposit again within 30 days, and agree to an additional $25.00 standard bank charge which
will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination
of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user
of this credit card or bank account. 


version 10-5-2015
© Copyright 2015-2019. All rights reserved. Powered by Novus Cannabis MedPlan and WCIG Insurance Service, LLC. | Void Where Prohibited