AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS) 

COMPANY NAME: CITY OF GENEVA
COMPANY ID NUMBER: 36-6005893

I (we) hereby authorize the CITY OF GENEVA, hereinafter called COMPANY, to initiate debit entries to

my (our) Checking account indicated below at the depository named below, hereinafter called DEPOSITORY, to debit the same to such account.

DEPOSITORY

NAME___________________________________ BRANCH______________________________

CITY____________________________________ STATE______________ZIP_______________

ROUTING NUMBER_______________________ ACCOUNT NO._________________________

This authorization is to remain in full force 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.

NAME(S)_________________________________ ID NUMBER___________________________

(PLEASE PRINT)

ADDRESS___________________________________________________

DATE_________________SIGNED X________________________SIGNED X___________________