AUTHORIZATION AGREEMENT FOR BANKDRAFT
 
I hereby authorize Crossroads Internet (MS Internet Services Group, Inc.) to initiate debit entries (bank drafts) to my checking account from the below listed bank.
 
 
Bank Name___________________________________   
 
 
Branch__________________________ (Location of Bank)
 
 
CITY__________________________________ STATE___________ ZIP_____________
 
 

Routing Number________________________ Account Number_________________
 
 
This authorization agreement will remain effective until Crossroads Internet has received written notification of bank draft termination.
 
 
Printed Name____________________________________________________
 
 
Signature________________________________________________________ Date____________
 
 

Attach voided check.
 
 
 
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