AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH CREDITS) Company Name : SoCal BARF I authorize the above company to initiate credit entries to my bank account. Name of my financial institution _____________________________ 9-Digit check routing number ________________________________ Checking or savings account number _________________________ This authorization will remain in effect until I provide SoCal BARF written notice of revocation. The notice of revocation must be provided to the same office to whom this authorization was made. I acknowledge that an initial deposit of $0.01 will be made to my account when it is set up for direct payments. This deposit is for the purpose of verifying my account and requires no additional steps on my part. Name (Printed) _________________________________________ Date ___________________________________ Signature ______________________________________________ Please FAX to 909-889-0099 or mail to SoCal BARF, 813 No D St, San Bernardino CA 92401

AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH CREDITS)

Company Name : SoCal BARF

I authorize the above company to initiate credit entries to my bank account.

Name of my financial institution _____________________________

9-Digit check routing number ________________________________

Checking or savings account number _________________________

This authorization will remain in effect until I provide SoCal BARF written notice of revocation. The notice of revocation must be provided to the same office to whom this authorization was made.

I acknowledge that an initial deposit of $0.01 will be made to my account when it is set up for direct payments. This deposit is for the purpose of verifying my account and requires no additional steps on my part.

Name (Printed) _________________________________________

Date ___________________________________

Signature ______________________________________________

Please FAX to 909-889-0099 or mail to SoCal BARF, 813 No D St, San Bernardino CA 92401