Cocoa Village Publishing


Setup Recurring Payments by QuantumGateway Processor

Use this form to request Recurring payments through our processor using Check Payments (EFT) or Credit Card payments (CC). If you prefer, just call us and we can do this over the phone.

Please enter adequate comments when processing so that after we receive notice from the processing service we can associate the payments with you and your service and modify through our merchant portal as required. Note an initial payment of a penny, $0.01, may be transacted immediately as part of the setup. If you have not already arranged a service with us nor bill/invoice, We recommend contacting us before using.

This form is to create a recurring payment with your checking account (EFT) or Discover-MC-Visa card (CC) through our processor. Enter comment to associate your payment with your service. If prefer to do by phone or questions - call/text (321)252-8133. ( We can change the settings if need through our merchant interface - Contact Us to make changes like day of month, amount or stop)

Frequency of Payments -default monthly

Preferred day of period for processing -default 1st

Amount Paying every period (we will modify amount after initial $0.01 test payment)



A reminder, we recommend that you have arrangements with us prior to using the processing links on this page, and the bank wants additional written authroization for EFT transactions. These links are here for convenience and are outside the typical shopping/invoice system. We may have sent this reference page for single payment in an email for an existing situation.


Facsimile Information for Electronic Funds Transfer

For payments by EFT (checks) after you go through all the processing please send/fax the following (because doing e-Checks can be more fraught with chargebacks). We believe it is very important to avoid improper charges and the associated fees. If your account has wrong charges, let us know asap, call us direct to resolve. To help processing checks by facsimille please send the following information and if feasible a voided check also. Please have any check used for example marked VOID. Send scan by email or snail mail.

I authorize Cocoa Village Publishing to initiate either an electronic debit or to create and process a demand draft against my bank account according to the terms outlined below. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law.
Bank Information
Bank ABA Number:
Bank Account Number:
Bank Account Type: [Checking/Savings/Business Checking]
This payment authorization is to remain in full force and effect until I, _______________, notify Cocoa Village Publishing of its cancellation by sending written notice in such time and in such manner to allow both the Cocoa Village Publishing and receiving financial institution a reasonable opportunity to act on it.
Customer Signature:
Customer Printed Name:
Date Signed: