AUTOMATIC EXTERNAL TRANSFER AUTHORIZATION

Sue Clark Real Estate Services

Customer Name

Date

Address

City

State

Zip

Bank Name

From Account Number

ABA Routing Number

Checking or Savings Account ______________________________________________ I authorize you to transfer ___________ as indicated above before the 15th day of each month beginning on and to do so until further notice. I may terminate this authorization at any time upon receipt of my written order to do so. In the event there is not sufficient funds in the account to effect the transfer, you are under no obligation to make the transfer.

Customer Signature Phone No._____________________________

ASSOCIATION NAME: PRAIRIE CREEEK VILLAS HOMEOWNERS ASSOCIATION

Attach VOIDED check here

Send to: Sue Clark Real Estate Services P.O. Box 71637 Clive, IA 50325

Office Use: ACH entered on Date by Employee Name