AUTHORIZATION AGREEMENT FOR
AUTOMATIC DEBITS (ACH DEBITS)

   I hereby authorize The Barefoot Bay Recreation District to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my bank account indicated below and the financial institution named below, to debit and/or credit the same to such account.  I understand there shall be a $25.00 charge for any insufficient fund transaction.

BANK INFORMATION

Account Type: (Please check one)   _________  Checking Account             __________  Savings Account

Financial Institution:  ___________________________________  Branch:  ________________________

City:   _________________________________________ State:  ___________ Zip:  _______________

Transit/ABA No.:  _____________________________   Account No.:   _________________________
                                                    (9 positions)

Transfer 1^st week of month ________________            Transfer 2^nd week of month  _________________

    This authority is to remain in full force and effect until the Barefoot Bay Recreation District has received written notification from me of its termination in such time and in such manner as to afford the Barefoot Bay Recreation District and the financial institution named above a reasonable opportunity to act on it.

 CUSTOMER INFORMATION

 Name:   ____________________________________________________________________________

 Address:  ___________________________________________________________________________

 Daytime Telephone Number:  __(_______)____________________________________________

 Customer Account Number:  _______________________________________________________

   A BLANK VOID CHECK MUST ACCOMPANY THIS APPLICATION.  DEPOSIT SLIPS CANNOT BE ACCEPTED.   ALL FIELDS MUST BE FILLED IN. INCOMPLETE FORMS WILL NOT BE ACCEPTED.