AUTO DRAFT AUTHORIZATION FORM
Company Name: LDC, llc
Tax Identification Number: 20-5228459
I (we) hereby authorize LDC, LLC, hereinafter called COMPANY, to initiate debit and/or credit entries to my (our) checking account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and, if necessary, initiate adjustments for any transactions credited/debited in error. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U. S. law. Please note that automatic drafting by credit card is no longer available.
This authorization is to remain in full force and effect until COMPANY 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.
SET AMOUNT: AMOUNT OF BILL
TRANSACTION DATE: 15TH OF EVERY MONTH
NOTE: In the case of revoked authorization, all written authorization may be revoked only by notifying the originator in writing no later than 15 days before the next transaction effective date.