MONTHLY PROGRAM PAYMENT AGREEMENTMonthly Payment Agreement • September 21st, 2010
Contract Type FiledSeptember 21st, 2010PurchaserName: Address: City: State: Phone: Zip: E-Mail: SellerAgent: Address: City: State: Phone: Zip: E-Mail: Fax: This Monthly Payment Authorization (this “Authorization”) authorizes Warrantech Automotive, Inc. (“Warrantech”) to charge Purchaser’s credit card or bank account, as designated below (referred to as the Designated Account), for the payments due under the above-referenced vehicle service contract (“VSC”) for the vehicle identified below. This Authorization shall remain in effect until terminated as explained below. This Authorization permits Warrantech to charge Purchaser’s Designated Account for the Activation Feethis date and on each Payment Date (as designated below) during each month this Authorization remains in effect for the Monthly Amount.