If your payment is returned unpaid,
you authorize [us / name of person collecting the fee electronically]
to make a one-time electronic fund transfer from your account to collect
a fee of [$ 
]. [If your payment is returned unpaid,
you authorize [us / name of person collecting the fee electronically]
to make a one-time electronic fund transfer from your account to collect
a fee. The fee will be determined [by] / [as follows]: [ 
].]