Bristol Harbour - Finger Lakes Weddings, Lodge, Dining and Golf

ACH House Membership - Payment Authorization Form

ristol Harbour ACH House Members pay their monthly bill through an ACH authorization, which automatically deducts the amount owed from your checking or savings account. When you sign up for a Bristol Harbour ACH House Membership, you’ll automatically receive a 10% discount* on all purchase made at the facility – giving you more for your money every time you visit! (*excludes weddings, banquets, and golf memberships)

Want to become an ACH House Member at Bristol Harbour? Fill out the form below to enroll today.

House Charge Account - ACH Payment Authorization Form

Primary Applicant Information
Secondary Address
Secondary Address To and From

Spouse Applicant Information
(only if seperate billing is required)

Authorized Users
Billing Information
Name on Account
Terms and Conditions
*I hereby authorize Bristol Harbour Lodge & Golf Club to charge my bank account, indicated above on the 7th of each month for payment of my house charge account. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Bristol Harbour Resort Management LLC 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 periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account on the above noted periodic transaction date. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that Bristol Harbour Resort Management LLC may process the charge again daily after the due date, and agree to an additional $30.00 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.