AFC Realty & Management, Inc



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AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS

(ACH Credits/Debits)

Company Name: AFC Realty & Management, Inc.

Company Tax ID Number: 84-0957237

I (we) hereby authorize AFC Realty & Management, hereinafter called COMPANY, to initiate credit entries to my (our) account, indicated below, at the depository named below, hereinafter called DEPOSITORY, to credit the same to such account.

Account Designation:

ð Checking

ð Savin Checking  Savings

Depository Name: ___________________________ Branch: _______________________

City: ________________________________ State: _________ Zip: _______________

Routing Number: _____________________________________

Account Number: _____________________________________

This authorization is to remain in full force and effect until COMPANY has received written notification of its termination, in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Name: _________________________________________ Tax ID #: ________________

(Please Print)

Signature: ______________________________________ Date: ___________________

E-Mail Address :___________________________________________________________

Name: _________________________________________ Tax ID #: ________________

(Please Print)

Signature: ______________________________________ Date: ___________________

E-mail Address :___________________________________________________________

Please attach a

voided Check here

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