Atwoods Forms

VENDOR AUTHORIZATION AGREEMENT
FOR AUTOMATIC DEPOSITS
( ACH CREDITS )

Company Name

This is Required!.

herebys authorize Atwood Distributing, L.P. to initiate credit entries to my bank account indicated below.

Depository Bank Name:

Bank Account Number:

Routing Number:

Account Type:

Checking

Savings

Federal tax ID or social security number:

Email address for payment notifications:

This authority is to remain in full force and effect until Atwood Distributing, L.P. has received written notification of its terminaition in such time and in such manner as to afford Atwood Distributing, L.P. a reasonable opportunity to act on it.

By entering my name in the signature box below, I agree that this agreement may be signed with an electronic signature, that an electronic signature shall be valid and binding for all purposes, and hereby waive any objection to use of an electronic version of this agreement as a substitute for the original for any legally recognized purpose.

Signature:

Date:

Title:

Attached Void Check

ATWOOD DISTRIBUTING, L.P