AUTHORIZATION FOR DIRECT PAYMENT 

I authorize IDEAL MOVERS & STORAGE, INC. to initiate debit entries to my checking/savings account. This authority will remain in effect until I notify you in writing to cancel it in such time as to afford the company a reasonable opportunity to act on it.

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NAME OF FINANCIAL INSTITUTION BRANCH

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CITY STATE ZIP CODE

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NAME AS IT APPEARS ON YOUR ACCOUNT - PLEASE PRINT

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SIGNATURE DATE)

Monthly payment amount: $________________ Regular payment date__________________

Unit #:___________________________

Checking or Savings

:

:

TRANSIT ROUTING NUMBER

ACCOUNT NUMBER INFORMATION

PLEASE ATTACH VOIDED CHECK

AND

MAIL TO:

IDEAL MOVERS & STORAGE, INC.

PO BOX 597

HADLEY MA 01035