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.

ACH (Automated Clearing House) GUIDELINES & PROCEDURES 1. 2. For an account to be set up on ACH, insured needs to sign an automatic debit authorization form and forward to IPFS with a voided check. IPFS Needs at least 10 days before the next payment due date. If authorization is received less than ten days before the

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  House, Authorization, Automated, Clearing, Automated clearing house

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