Authorization Agreement for ACH Payment

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Client Name (required)

Debtor Name (required)

Email (required)

Balance Due (required)

RE: Payment Terms: The debtor company listed above authorizes Alexander, Miller & Associates LLC c/o the client listed above to draft the amounts listed below from the account listed below on the following dates:

Bank Information

Bank Name (required)

City (required)

State (required)

Name on Check or account (required)

Address on Check or account (required)

Type of Bank Account (Check One)

Individual Commercial

Routing Number (ABA Number, 9 Digits)

Account Number (Required)

Check Number (Required)

Draft Date (Required)

Draft Amount (Required)

Date (Required)

Signature (Required)

MANDATORY FOR ALL INDIVIDUAL ACCOUNTS OR COMMERICAL ACCOUNTS PLEASE FAX BACK TO :281-741-5553

I/We hereby authorize Alexander, Miller & Associates LLC or any of its operating subsidiaries to initiate ACH payment for the amounts listed herein, on the dates listed above from the checking account listed above.

Printed Name as it appears on check or account (Required)

Identifying your account can be difficult sometimes, therefore, Please Attach a Voided Check

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We hereby grant power of attorney to the above account(s) to Alexander, Miller & Associates. We authorize Alexander, Miller & Associates to collect the amounts owing, any additional interest and collections fees that are due us as legal and just. Commission will be charged on any funds collected; paid directly to client or settled by negotiations or return of merchandise. A cancellation fee will be charged on any account that is inappropriately cancelled or due to interference from client once Alexander, Miller & Associates has been retained. Cancellation fee will be full fee due or 15% of balance. Waiver of cancellation fees will be based upon just cause; our corporate attorneys will review any discrepancies. In event litigation deems necessary, unless Harris County, Houston, Texas we direct and authorize you, as our attorney in fact, to send the above accounts) to an attorney, designed by us, in the county of Debtor, and whose name appears in the Columbia Law List Publication, according to prevailing rates in the county. We authorize you, as our attorney in fact, to accept payments, endorse checks, notes, money orders, or bank drafts for deposit; the net proceeds for which you are to submit to us. Special authorization is required to file suit, compromise, or to grant extensions. For contractual issues, all jurisdiction vests Harris County, Houston, Texas. Agency's remittance to client shall be processed the week of the 15th of each month for all funds received and cleared through the banking system by the first of the previous month minus agency's fees.