This
is my authorization agreement for automatic draft on my bank account to Cal Farley's,
Federal ID number 75-0808768. I
(we) hereby authorize Cal Farley's, _______________,
20__. DEPOSITORY NAME:_________________________________
BRANCH:________________________________ ADDRESS:_________________________________________________________
____ CITY: ROUTING
NUMBER:_____________________ ACCOUNT NUMBER:______________________ This
authorization is to remain in full force and effect until Cal Farley's has
received written notification from me (or either of us) of its termination in
such time and in such manner as to afford Cal Farley's and DEPOSITORY a
reasonable opportunity to act on it. My
(our) Name(s):_____________________________________________________ Street
Address:________________________________________________________ City:_________________________________________________________________ State:________________
Zip:__________________ Phone Number:______________ E-Mail
Address:_________________________________________________________ |