AUTHORIZE EATERIES, INC., HEREINAFTER CALLED COMPANY, TO INITIATE
DEBIT ENTRIES TO OUR CHECKING ACCOUNT INDICATED BELOW AND THE DEPOSITORY NAMED
BELOW, HEREINAFTER CALLED DEPOSITORY, TO DEBIT THE SAME TO SUCH ACCOUNT.
DEPOSITORY NAME
BRANCH
CITY ______________________________STATE_________ZIP
TRANSIT/ABA NO.____________________ACCT. NO.
THIS AUTHORITY IS TO REMAIN IN FULL FORCE AND EFFECT UNTIL COMPANY AND
DEPOSITORY HAS RECEIVED WRITTEN NOTIFICATION FROM ME (OR EITHER OF US) OF ITS
TERMINATION IN SUCH TIME AND IN SUCH MANNER AS TO AFFORD COMPANY AND DEPOSITORY
A REASONABLE OPPORTUNITY TO ACT ON IT.
NAME_______________________________________ ID#
DATE___________________ SIGNED
SIGNED