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Payment Authorization Form
1. Account Holder Information: Details of the individual or entity authorizing the payment, including full name, address, and contact information
2. Bank Account Details: Complete banking information including account number, bank name, and IBAN
3. Payment Details: Specification of payment amount, frequency (if recurring), and purpose of payment
4. Authorization Declaration: Clear statement of what the account holder is authorizing, including the specific permissions being granted
5. Data Protection Notice: GDPR-compliant statement about how the payment and personal data will be processed and stored
6. Termination Rights: Information about how to cancel or modify the payment authorization
7. Signature Block: Space for date and signature (whether electronic or physical)
1. Direct Debit Mandate: Additional section required when the authorization is for direct debit payments, including SEPA mandate information
2. Third Party Authorization: Required when someone other than the account holder is authorized to manage the payment arrangements
3. Multiple Payment Schedule: Used when authorizing varying payment amounts or frequencies over time
4. International Payment Terms: Required for cross-border payment authorizations, including currency conversion terms
5. Corporate Authorization: Additional section for corporate accounts requiring proof of authority to sign
1. Schedule A - Payment Schedule: Detailed breakdown of payment dates, amounts, and frequencies if payments are recurring
2. Schedule B - Terms and Conditions: Detailed terms and conditions of the payment service provider
3. Appendix 1 - Supporting Documentation: List of required supporting documents (ID verification, company registration, etc.)
4. Appendix 2 - Privacy Policy: Detailed privacy policy and data processing information as required by GDPR
Authors
Authorization
Bank Account
Bank Business Day
Billing Date
Commencement Date
Data Protection Laws
Direct Debit
Due Date
Electronic Signature
GDPR
IBAN
Payment Amount
Payment Date
Payment Instruction
Payment Method
Payment Provider
Payment Schedule
Payment Services
Personal Data
Processing
Recurring Payment
Revocation
SEPA
Service Provider
Single Payment
Standing Order
Statement
Terms and Conditions
Transaction
Valid Consent
Working Day
Payment Terms
Data Protection
Consent
Account Details
Payment Schedule
Processing Terms
Modification Rights
Termination Rights
Revocation Rights
Security Measures
Authentication
Liability
Force Majeure
Governing Law
Privacy
Dispute Resolution
Communication
Service Provider Rights
Account Holder Rights
Documentation Requirements
Confidentiality
Electronic Signatures
Notices
Amendments
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Genie’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; Genie’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
Our bank-grade security infrastructure undergoes regular external audits
We are ISO27001 certified, so your data is secure
Organizational security
You retain IP ownership of your documents
You have full control over your data and who gets to see it
Innovation in privacy:
Genie partnered with the Computational Privacy Department at Imperial College London
Together, we ran a £1 million research project on privacy and anonymity in legal contracts
Want to know more?
Visit our Trust Centre for more details and real-time security updates.
Read our Privacy Policy.