Authorization for Check by Fax Payment ACH Paying…

                    Authorization for Check by Fax Payment ACH
Paying by check by fax is a faster way to pay for your order via check. Please fill out the form
below completely and fax it, along with a copy of a voided check, to us at 951-372-8099.
Your funds will be deducted from your checking account within 24 hours. Once the funds have
been cleared and deposited into our account via the ACH deposit process, your order will be
processed.

Company Name: Everything Furniture Inc.___________________
I (we) authorize Everything Furniture Inc., to initiate variable entries to my (our) account
described below:
Checking Account No.:_________________________________________________________

Savings Account No.:__________________________________________________________

Financial Institution's Name:_____________________________________________________

Financial Institution's Address:___________________________________________________
____________________________________________________________________________

Please write the financial institutions routing number and attach a voided check
____________________________________________________________________________
(The routing number can be found between these symbols |:_ _ _ _ _ _|: on the bottom left
of your check).

This authority is to retain in full force and effect until Everything Furniture Inc. has received
written notification from me (or either one of us) of its termination in such time and manner as
to afford Everything Furniture Inc. a reasonable opportunity to act on it.

Full Name: __________________________________________________________________
Address: ____________________________________________________________________

Telephone No.: _______________________________________________________________

Amount to be released to Everything Furniture Inc.: _$_____________________________

Signature: __________________________________________ Date:____________________

(Optional - for Joint Account)

Full Name: ___________________________________ Telephone No.:___________________

Signature:___________________________________________ Date:____________________

Internal use only:
Received by: ___________________________Date:________ Voided check attached:______
Comments:___________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
ACH020608