AUTHORIZATION AGREEMENT FOR AUTOMATIC DEBITS – Asbury House Child Enrichment Center

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I/we hereby authorize,

Asbury House Child Enrichment Center, hereinafter called COMPANY, to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our) account indicated above and the bank named above, hereinafter called BANK, to debit and/or credit the same to such account.

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

COMPANY will withdrawal the requested amount of funds from BANK on the 5^th of every month beginning the 5^th of the month following the date the form was signed.

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