ACH DEBIT AUTHORIZATION Form  AUTHORIZATION AGREEMENT - For Pre-Arranged Payments (ACH Debits)  Company Name: I(we) hereby authorize:  hereinafter called COMPANY, to initiate debit entries to my (our) Checking Savings account indicated below and the depository NOTE: The dollar amount indicated will be drawn from account indicated beiow on the last business day of each month.  named below, hereinafter called DEPOSITORY, to debit the same to such account.  Recurring Set Amount: Depository Name Account Type  Range: Minimum $_ Maximum $ Depository, Address  Transit IABA Number  Account Number  CHECKING SAVINGS  This authorityi is tor remain in full force and effect until COMPANY and DEPOSITORY has received written notification from me (ore either of us) ofi its termination ins such time and in such manner as to: afford COMPANY and DEPOSITORY: a reasonable opportunity to act oni it. I(or either of us) has the right to stop payment ofac debit entry! by notification to DEPOSITORY at such time as to afford DEPOSITORYa reasonable opportunity to act oni it prior to charging account. After account has been charged, have the right tol have the amount ofa an erroneous debiti immediately credited to my: account by DEPOSITORY, providedI (we) send written notice ofs such debite entryi in error to DEPOSITORY within 15 days following issuance oft the account statement or 45 days after posting, whichever occurs first.  Please attach av voided check for account verification purposes.  Date:  20  Name (please print) Signature  Name (please print) Signature