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IPFS CORPORATION AUTOMATIC DEBIT AUTHORIZATION

IPFS CORPORATIONAUTOMATIC DEBIT AUTHORIZATIONName & Address of Insured/Borrower:Telephone BOX 15089 Please attach a voided check or a deposit slip from your bank account , and verify with your bank thatthe bank routing number for ACH transactions is the same as listed on your check or deposit Institution:ABA #/Routing # (9 digits):Address (City, State, Zip):Number of Payments:Payment Amount:First Payment Due:Note: Funds should be available within the account as of the payment due date. If the DEBIT date falls on a weekendor holiday, IPFS may DEBIT the account on the business day prior to the weekend or the (1) I hereby authorize IPFS CORPORATION (IPFS) to initiate electronic DEBIT entries to the account indicated on this form,from the financial institution hereinafter referred to as BANK. I authorize BANK to honor the DEBIT entries initiated by IPFSand DEBIT the same to such account .

IPFS CORPORATION AUTOMATIC DEBIT AUTHORIZATION Name & Address of Insured/Borrower: Telephone Number: IPFS P.O. BOX 15089 Please attach a voided check or a deposit slip from your bank account, and verify with your bank that

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  Account, Automatic, Authorization, Corporation, Debit, Fips, Ipfs corporation automatic debit authorization

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