Ellen's Stardust Diner - Home of the World Famous Singing Waitstaff
1650 Broadway (at 51st Street) | New York, NY 10019
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The Ellen's Stardust Diner is hereby fully empowered and authorized to withdraw and pay funds from the undersigned account for the payment of any and all charges billable to the account first identified above. I understand that the amount may vary according to the products and/or services purchased, contracted and/or received. It is understood and agreed that Ellen's Stardust Diner shall not be required to pay any funds as a result of these instructions if there are insufficient funds in the account. Ellen's Stardust Diner shall be indemnified and held harmless from any loss suffered or liability incurred by reason of any act or omission made in compliance with the authorization contained herein The authority and indemnification hereby conferred shall remain in full force and effect unless and until expressly revoked or modified at least thirty (30) days prior to the date any proposed revocation or modification is to become effective. If Ellen's Stardust Diner is unable to process my payment, I will be responsible for an alternate payment arrangement and any resulting fees.