AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)

Name ______________________________

Username __________________________

I (we) hereby authorize ___________________________________, hereinafter called NetOne Communications, Inc., to initiate debit entries to my (our) Checking Account / Savings Account (circle one) indicated below at the depository financial institution named below, and to debit the same to such account.   I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

Depository Name ___________________

Branch ____________________________

City ______________________________

State __________

Zip ____________

Routing Number ____________________

Account Number ____________________

This authorization is to remain in full force and effect until NetOne Communications, Inc. has received written notification from me (or either of us) of its termination in such time and in such manner as to afford NetOne Communications, Inc. and Depository a reasonable opportunity to act on it.
Name(s) ___________________________ Username __________________________
(Please Print)

Date_______________________________
Signature__________________________