AUTHORIZATION AGREEMENT FOR AUTOMATIC PAYMENTS (ACH CREDITS)
NAME ____________________________________ ACCT NUMBER______________
I
(we) hereby authorize Data Net Systems, L.L.C./IPP Escrow Trust Account credit
entries and to initiate, if necessary, debit entries and adjustments for
any credit entries
in
error to my (our) [ ] CHECKING account.
Indicated below and the depository
named
below, hereinafter called DEPOSITORY, to debit the same to such account.
NAME______________________________ BRANCH_____________________________
CITY_______________________________ STATE_______________ZIP_____________
TRANSIT/ABA
NO.___________________ ACCOUNT NO.________________________
This authority
is to remain in full
force and effect until DATA NET SYSTEMS has
received written
notification from me (or either of us) of its termination in such
time and in
such manner as to afford DATA
NET SYSTEMS and DEPOSITORY a reasonable opportunity to act on it.
NAME(S)___________________________ ID NUMBER___________________________
(Please Print)
SIGNED X_______________________________