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Please mail to:
Cal Farley's
P.O. Box 1890
Amarillo, Texas 79174-0001

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, Amarillo, Texas, to initiate debit entries to my (our) bank account indicated below at the depository named below in the amount of $_______, on the 1st or 15th day of each month beginning

_______________, 20__.

 

DEPOSITORY

NAME:_________________________________ BRANCH:________________________________

ADDRESS:_________________________________________________________ ____

CITY:__________________________________ STATE:_____________ ZIP:________________

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:_________________________________________________________