* = REQUIRED
I hereby authorize Eastern Oregon Net, Inc. to initiate debit entries to my
account indicated above, and hereby authorize the BANK DEPOSITORY named above to debit the same to such account.
This authorization is to remain in full force and effect until Eastern Oregon Net, Inc., has received written
notification from me of authorization termination (or Notification by Eastern Oregon Net, Inc., of account
termination, in such time and and in such manner to afford Eastern Oregon Net, Inc., a reasonable opportunity
to act upon it.