Auth Form Bank Account by Mtri58q



South Hill Finance       ****PLEASE SIGN AND INCLUDE VOID CHECK****
RR 1 Site 8 Comp 39                   FAX BACK TO
Christopher Lake, Sask.             TOLL FREE FAX 1-877-241-3676
S0J 0N0
TOLL FREE PHONE 1-866-245-5551

                                    Loan # _____________________

Please Charge (our) payment to

____________________________                     __________________________________________
Full Name (as appears on account)                Bank Account Number

____________________________                     __________________________________________
Mailing Address                                  Bank Transit Number

____________________________                     __________________________________________
City, State or Province, Zip Code                Indicate Personal Checking, Corporate Checking
                                                          Personal Savings, Corporate Savings

       I (we) hereby authorize South Hill Finance hereinafter called the COMPANY to initiate a
monthly charge from my (our) bank account, Indicated above on the 1st or the 15th (circle one) day of
each month, commencing _____________ , 20_____in the amount of $_________.

Account Holder Signature

Print Name

I (we) understand and authorize that in the event of INSUFFCEINT FUNDS that the monthly payment
will be taken AUTOMATICALLY on the following credit card provided, PLUS a $20.00 NSF fee.

Card Holder Name________________________________

Card Number ____________________________________ Exp Date _______________

This authority shall remain in full force and effect until the loan balance is paid in full. This
authorization will be automatically renewed on a year to year basis from the bank account until the
contract balance is paid in full to the COMPANY

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