AUTHORIZATION AGREEMENT
FOR PRE-ARRANGED PAYMENTS (ACH DEBITS)

I (we) hereby authorize United Leasing, Inc. hereinafter called Lessor (also to mean Lender) to initiate debit entries, and to initiate, if necessary, credit entries and adjustments for any debit entry in error, to my (our) * account indicated below and the depository named below, hereinafter called DEPOSITORY, to debit the same to such account.

This authorization is for $ * (monthly payment amount). In addition, I (we) authorize Lessor to initiate debit entries for property taxes, fees, etc., which become due and payable under the terms of the lease or loan.

I (we) understand that the entry will occur on or around the * of each month (within 10 days of lease/loan due date), starting in *. In the event there are insufficient funds in my (our) account to satisfy its monthly obligation, Lessor may apply a $25.00 service charge each time this occurs. * denotes required fields
Depository Bank*
Bank Branch
City
State
Zip Code
Transit/ABA No.*
Account Name*
Account Number*

This authority is to remain in full force and effect until Lessor has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Lessor and DEPOSITORY a reasonable time to act on it, but in no event will occur later than three (3) business days prior to the scheduled date of the transaction.
Customer Number* (As displayed on coupon/statement)
Authorized Signer* (for the above account)
Phone Number*
Email Address
Date (mm-dd-yyyy)*
By submitting this form and checking the box below it is as if giving your official signature as Authorized Signer. This signature shall be deemed an original signature for all purposes.