DRAFT by liwenting

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									                       BI-WEEKLY DRAFT

I, ______________________________, HEREBY ALLOW THE HOOK
UP TO DIRECTLY DRAFT THE INITIAL DOWN PAYMENT OF
ONE HUNDRED DOLLARS ($100.00) THEN THEREAFTER
FIFTY DOLLAR ($50.00) BI-WEEKLY PAYMENTS DIRECTLY
OUT OF THE ACCOUNT STATED BELOW:

Banking Information:

Type of Card: (circle one) VISA   MASTERCARD DISCOVER


CARD NUMBER: ______________________________________

EXPIRATION OF CARD: _____________________

Name and Address where statement is mailed:


Phone Number: _____________________

WITH THE SIGNING OF THIS I HEREBY ACKNOWLEDGE
THAT THIS IS MY ACCOUNT AND HAVE PERMISSION TO
DIRECTLY DRAFT THIS AMOUNT OF THE ACCOUNT.

SIGNED: _____________________________________

DATE: _________________________

								
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