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BillSlash Customer Signup

Full Name

Email Address

Phone Number

Street Address

City

Zip

Provider Details

Provider Name

What services do you have with this provider?

A
B
C
D

Account holder name as it appears on bill

Street address on account

City

Zip

Account number

Account PIN or Passcode

Current monthly bill amount

Copy of the Bill

Why do you want to lower your bill?

A
B
C
D

To help lower your bill, would you be open to removing any services?

A
B
C
D

Anything else we should know? (Optional)

Tell us which services you may consider removing or any services you definitely want to keep.
Your selection only tells us what offers we may explore. BillSlash will get your approval before removing or changing any service.

Third-Party Authorization & Service Agreement

Effective Date: Date of Acceptance
1. Purpose of This Agreement

This Third-Party Authorization & Service Agreement ("Agreement") authorizes BillSlash ("Company") to act as your limited authorized representative solely for the purpose of negotiating lower recurring rates, promotional pricing, discounts, credits, or improved service plans with your designated service provider(s).

By accepting this Agreement, you acknowledge that you have read, understood, and agree to the terms set forth below.

2. Refundable Deposit

A $25.00 refundable deposit will be charged upon submission of your request.

This deposit serves to verify your payment method and initiate the negotiation process.

If BillSlash successfully secures savings on your behalf, the deposit will be applied as a credit toward your success fee.

If BillSlash is unable to secure any qualifying savings, your deposit will be refunded in full.

3. Authorization to Negotiate

You authorize BillSlash to communicate directly with your designated service provider(s) for the limited purpose of negotiating lower recurring monthly rates, promotional pricing, discounts, credits, or improved service plans. This authorization includes permission to communicate with customer service, billing, loyalty, and retention departments, verify your account using the information you provide, request available promotional offers, discuss account pricing, and receive confirmation numbers or other information necessary to complete the negotiation process.

This authorization does not permit BillSlash to cancel or disconnect your service, enter into any new long-term contract or service commitment without your prior approval, purchase products or services on your behalf, make payments on your account, access or modify your payment methods, or use your account for any purpose unrelated to negotiating lower recurring costs.

4. Success Fee

If BillSlash successfully negotiates a lower recurring monthly rate or promotional offer on your behalf, you agree to pay a success fee equal to twenty-five percent (25%) of the total savings realized during the negotiated promotional pricing period.

For purposes of this Agreement, "Promotional Savings" means the difference between your previous recurring monthly charges and your new negotiated recurring monthly charges, multiplied by the number of months included in the negotiated promotional pricing period. One-time courtesy credits, rebates, gift cards, taxes, government fees, equipment purchases, installation charges, activation fees, or other non-recurring adjustments are not included in the calculation of Promotional Savings unless specifically identified in your Savings Summary.

5. Savings Summary and Payment Authorization

Upon completion of a successful negotiation, BillSlash will provide you with a written Savings Summary identifying your previous recurring monthly rate, your new negotiated recurring monthly rate, the length of the promotional pricing period, the total Promotional Savings achieved, the applicable success fee, the credit for your $25.00 refundable deposit, and the remaining balance due.

By accepting this Agreement, you expressly authorize BillSlash to charge the payment method used for your initial deposit for the remaining success fee. BillSlash will not process this charge until three (3) calendar days after the Savings Summary has been delivered to you.

If you believe the Savings Summary contains a mathematical, factual, or billing error, you must notify BillSlash in writing within the three (3) calendar day review period. If no dispute is received within that period, you authorize BillSlash to charge the remaining balance to your payment method on file without further authorization.

This authorization remains valid until the negotiation is completed or for 12 months from the date signed, whichever occurs first, unless revoked by me in writing.
6. No Savings Guarantee
If BillSlash is unable to secure qualifying savings on your behalf, no success fee will be charged, and your $25.00 refundable deposit will be refunded in full.
7. Customer Representations
You represent and warrant that all information you provide to BillSlash is true, accurate, and complete, that you are the account holder or otherwise legally authorized to act on the account, and that you have the authority to grant the permissions contained in this Agreement. You further agree to promptly notify BillSlash of any material changes to your account information while negotiations are pending.
8. Term and Revocation
This authorization becomes effective immediately upon acceptance and shall remain in effect until the earliest of the completion of the requested negotiation services, your written revocation of this authorization, or twelve (12) months from the date of acceptance.

Cancellation During the Review Period
If BillSlash has delivered a Savings Summary confirming qualifying savings and you submit a written cancellation request before the scheduled charge date during the three (3) calendar day review period, BillSlash will retain the $25.00 deposit as compensation for completed work and will waive the remaining success fee. Cancellation does not reverse or cancel any provider plan, pricing, or account changes already approved by you or implemented by the provider. You remain responsible for contacting the provider regarding those services.
9. Acceptance
By checking the required boxes and submitting this form, you acknowledge and agree that you authorize BillSlash to communicate with your designated service provider(s) as your limited authorized representative for the purposes described in this Agreement. You further authorize BillSlash to charge your payment method for the remaining success fee, after application of your refundable deposit, following delivery of your Savings Summary and expiration of the three (3) calendar day review period, unless you notify BillSlash of a billing dispute within that period. You acknowledge that BillSlash's success fee is equal to twenty-five percent (25%) of the Promotional Savings achieved during the negotiated promotional pricing period, certify that all information you have provided is true and accurate, and agree to be bound by this BillSlash Service Agreement & Limited Authorization and the BillSlash Terms and Conditions.

I have read and agree to the BillSlash Service Agreement & Limited Authorization, Terms & Conditions, and Privacy Policy. I authorize BillSlash to negotiate with my designated service provider(s) on my behalf, acknowledge the $25.00 refundable deposit, authorize BillSlash to charge my payment method for any applicable success fee as described in the Agreement, and certify that the information I have provided is true and accurate.