Authorization for ACH Transfer New Automatic Transfer Change Existing Transfer Cancel Existing Transfer Institution Name Wells Fargo Bank, N.A. Transfer From Account Name Account Number Transfer To Name on Account Financial Institution Routing Transit Number (The 9 digit number between the two colons on the bottom left of your check) Account Number Type of Account Checking Savings Other I (we) authorize Wells Fargo to make debit entries in the form of ACH transfers or other automatic transfers from the account identified above in the section entitled Transfer From for the purpose of completing the transfers described above. I (we) acknowledge that the origination of automatic transactions to my (our) account must comply with the provisions of U.S. Law and the Operating Rules of the National Automated Clearing House Association. If the settlement date of a transfer falls on a weekend or holiday, my (our) payment will be credited as of the next business day. This authorization may be cancelled by completing a new copy of this form and sending to: Name of Primary Account Contact Address of Primary Account Contact Wells Fargo must be notified of cancellation of this authorization at least 10 days prior to the date I (we) wish the cancellation to be effective. I (we) further acknowledge receiving a copy of this authorization. Client Name (print) Client Name (print) Client Signature X Client Signature X Note: Please sign and submit this form if you are requesting, changing or canceling automatic transfers. Date Date 2014 Wells Fargo Bank, N.A. All rights reserved 590709 (Rev 00-05/14) Authorization for ACH Transfer Page 1 of 1