Automatic Monthly Deductions Authorization Agreement

EXHIBIT 99.3

Automatic Monthly Deductions Authorization Agreement

FILL IN THE INFORMATION BELOW FOR STOCK PURCHASES USING AUTOMATIC MONTHLY DEDUCTIONS.

Please Print All items

1. Type of Account            Checking            Savings

Bank account Number

a. Name of Bank Account

Financial Institution

Branch Name

Branch Street Address

Branch City. State and Zip Code

$ ABA Number            Amount of automatic deduction

PLEASE CONFIRM ITEMS 2 AND 5 WITH YOUR BANK PRIOR TO SUBMITTING THIS APPLICATION.

Name on bank account

XXXX X. XXX XXXX X. XXX

000 XXXX XXXXXX

ANYWHERE. U.S.A. 12345 03850

670

PAY TO THE

ORDER OF___$

Financial institution and branch information

DOLLARS

First National Bank of Anywhere 000 Xxxx Xxxxxx Xxxxxxxx, X.X.X. 12345

FOR___SAMPLE (NON-NEGOTIABLE)

07100013 123456789

ABA Number            Bank Account Number

S-19