By signing this agreement, I authorize the account indicated above for the purpose of expense and/or payroll transactions.

I also authorize the initiation of debit entries and adjustments, if necessary, to correct any credit entries made in error.

If the account is a joint account or in someone else's name, that individual must also agree to the term stated above before signing below.

HOW TO COMPLETE THIS FORM

1) Fill all the necessary data in the boxes above.

2) Sign and date the form.

TIPS:

1) Call your financial institution to make sure they accept direct debit.

2) Verify your account number and routing transit number with your financial institution.

3) Do not use a deposit slip to verify the routing number.