Authorization Agreement For Direct Bank Charges

I authorize Automatic Funds Transfer Services, Inc. (AFTS) to initiate charges to my account indicated below, and the bank named below to charge that account.   These charges will be made for the use of MoveUpdate services at current published prices.

BANK ACCOUNT INFORMATION

Bank Name: ____________________________________________________

Branch: ________________________________________________________

City: _______________________   State:   _________  Zip: ______________

Transit/ABA No.: ________________  Account No.: __________________

Authorized Signature: ____________________________ Date: _________ 

This authority is to remain in full force and effect until AFTS has received notification from me of its termination.

CUSTOMER INFORMATION

Company Name: _______________________________________________

Customer ID (if already assigned): ___________________

Customer Name (Please Print): ___________________________________

Title: _____________________________________

Phone: ______________________      FAX: ___________________________

INSTRUCTIONS:

1. Print this form directly from your internet browser.
2. Fill out this form completely and don't forget to sign it.
3. Mail this form along with a deposit slip or voided check to: MoveUpdate Support, 151 South Lander St. STE C, Seattle, WA 98134.  If you need immediate service, then you may FAX this form to us.   However, we will still need to receive the original copy in the mail.  You can reach us by FAX at: ATTENTION: MoveUpdate Support, FAX: (206) 254-0968.