Authorization Agreement for Direct Payment (ACH  Debit)
(Contract Buyer)




I/we hereby authorize KANSAS SECURED TITLE AND ABSTRACT CO., INC., hereinafter called COMPANY, to initiate debit entries to my/our

   Checking Account        Savings Account

indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to debit the same to such account. I/we acknowledge that the origination of ACH transactions to my/our account must comply with the provisions of U.S. law.


Depository Name:     Branch:
City:
    State:      Zip:  
Bank Routhing Number (9 digits): 
Account Number:

This authorization is to remain in full force and effect until COMPANY has received written notification from me/us of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

Customer Names:

Please make my deduction on the:
1st     5th     10th     15th     20th     25th

Contract Number:    Last 4 digits of SSN/TIN (for verification):