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Authorization Agreement For Automatic Deposits (Credits)

Name
SS#
Account Number
Type of Account Savings
Checking

I hereby authorize Petroleum Associates FCU to initiate credit entries to my account indicated above and the depository named below, hereinafter called depository, to credit the same to such account.

Petroleum Associates FCU
4127 Winters Chapel Rd

Doraville, GA 30360

Transit Routing Number: 2610-7332-6

This authority may be terminated upon thirty days prior written notification of its termination from me to Petroleum Associates, Motiva.