Common use of AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS Clause in Contracts

AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS. I (we) hereby authorize Xxx t State University to initiate debit (take from) and where appropriate credit (add to) my (our) Checking Savings indicated below and the depository named below, hereinafter called Financial Institution, to debit the same to such account. Please assure that your financial institution has automated debit/credit capabilities for the account listed below. In the event that Kent State University deposits funds erroneously into my (our) account, I (we) authorize Kent State University to debit my (our) account for an amount not to exceed the amount of the erroneous deposit. FINANCIAL INSTITUTION CITY STATE TRANSIT/ABA NO. BRANCH BANK PHONE NO. ( ) ACCOUNT NO. This authority is to remain in full force and effect until Kent State University and Financial Institution have received written notification from me (us) of its termination in such time and in such manner as to afford Kent State University and Financial Institution a reasonable opportunity to act on it or upon completion of the 30th monthly payment. NAME(S) ON ABOVE ACCOUNT SSN NUMBER DATE SIGNED X DAYTIME PHONE NO. DATE STUDENT/PARTICIPANT X X (if under 18 years of age) or (if 18 or old er) DATE BURSAR REPRESENTATIVE X

AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS. I (we) hereby authorize Xxx t Kent State University to initiate a debit (take from) and where appropriate credit (add to) my (our) Checking Savings Savings  indicated below and the depository named below, hereinafter called Financial Institution, to debit or credit the same to such account. Please assure that your financial institution has automated debit/credit capabilities for the account listed below. In the event that Kent State University deposits funds erroneously into my (our) account, I (we) authorize Kent State University to debit my (our) account for an amount not to exceed the amount of the erroneous deposit. FINANCIAL INSTITUTION BRANCH CITY STATE TRANSIT/ABA NO. BRANCH BANK PHONE NO. ( ) TRANSIT/ABA NO ACCOUNT NO. This authority is to remain in full force and effect until Kent State University and Financial Institution have received written notification from me (us) of its termination in such time and in such manner as to afford Kent State University and Financial Institution a reasonable opportunity to act on it or upon completion of the 30th 24th monthly payment. NAME(S) ON ABOVE ACCOUNT SSN NUMBER DATE SIGNED X DAYTIME PHONE NO. DATE STUDENT/PARTICIPANT X X (if under 18 years of age) or (if 18 or old erolder) DATE BURSAR REPRESENTATIVE XX CONTINUED ON PAGE 2

AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS. I (we) hereby authorize Xxx t Kent State University to initiate a debit (take from) and where appropriate credit (add to) my (our) Checking □Savings □ indicated below and the depository named below, hereinafter called Financial Institution, to debit or credit the same to such account. Please assure that your financial institution has automated debit/credit capabilities for the account listed below. In the event that Kent State University deposits funds erroneously into my (our) account, I (we) authorize Kent State University to debit my (our) account for an amount not to exceed the amount of the erroneous deposit. FINANCIAL INSTITUTION BRANCH CITY STATE TRANSIT/ABA NO. BRANCH BANK PHONE NO. ( ) TRANSIT/ABA NO ACCOUNT NO. This authority is to remain in full force and effect until Kent State University and Financial Institution have received written notification from me (us) of its termination in such time and in such manner as to afford Kent State University and Financial Institution a reasonable opportunity to act on it or upon completion of the 30th 24th monthly payment. NAME(S) ON ABOVE ACCOUNT SSN NUMBER DATE SIGNED X DAYTIME PHONE NO. DATE STUDENT/PARTICIPANT X _ X (if under 18 years of age) or (if 18 or old erolder) DATE BURSAR REPRESENTATIVE XX CONTINUED ON PAGE 2

AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS. ❑ ❑ I (we) hereby authorize Xxx t Kent State University to initiate debit (take from) and where appropriate credit (add credit(add to) my (our) Checking Savings indicated Indicated below and the depository named below, hereinafter called Financial Institution, to debit the same to such account. Please assure that your financial institution has automated debit/credit capabilities for the account listed below. In the event that Kent State University deposits funds erroneously into my (our) account, I (we) authorize Kent State University to debit my (our) account for an amount not to exceed the amount of the erroneous deposit. FINANCIAL INSTITUTION BRANCH CITY STATE TRANSIT/ABA NO. BRANCH BANK PHONE NO. ( ) TRANSIT/ABA NO. ACCOUNT NO. This authority is to remain in full force and effect until Kent State University and Financial Institution have received written notification from me (us) of its termination in such time and in such manner as to afford Kent State University and Financial Institution a reasonable opportunity to act on it or upon completion of the 30th 42nd monthly payment. NAME(SNAME (S) ON ABOVE ACCOUNT SSN NUMBER DATE SIGNED PARENT/GUARDIAN/SPONSOR X DAYTIME PHONE NO. DATE STUDENT/PARTICIPANT X X (if under 18 years of age) or (if 18 or old erolder) DATE BURSAR REPRESENTATIVE X