Authorization for Direct Payment Automatic Bill Payment

I (we) authorize OPC Marketing (the "Company") to initiate variable entries to my (our) account described below:

Checking Account No. _________________________ Savings Account No. ____________________________

Financial Institution's Name ___________________________________________________________________

Financial Institution's Address _________________________________________________________________

Attach a voided check (below)
OR provide the financial institution's routing number _______________________________________________

__ __ __ __ __ __ __ __ __

Please Note: The routing number is found between the above symbols on the bottom left of your check

This authority is to remain in full force and effect until the Company has received written verification from me (or either one of us) of its termination in such time and manner so as to afford the Company a reasonable opportunity to act on it.

Signature ____________________________________ Full Name ___________________________________

Address _____________________________________ City / State / Zip ______________________________

Date ________________________________________ Telephone No. ________________________________

Billing Account No. ____________________________

(Optional - For Joint Account)

Signature ____________________________________ Full Name ___________________________________

Address _____________________________________ City / State / Zip ______________________________

Date ________________________________________ Telephone No. ________________________________

Attach Voided Check Below