ACH Authorization

Business Name

Business Address

I, on behalf of the business listed above (the “BUSINESS”), hereby authorize OCCAMS ADVISORY (“OCCAMS”), and their payment processor(s), to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries made in error to the BUSINESS'S Checking Account Savings Account (Select one) at the depository institution named below (“DEPOSITORY”), per the authorization below. I understand the BUSINESS will be charged the Aggregate Service Fee and any other applicable fees as per the Engagement Letter for Consulting Services Agreement Appendix C “Schedule of Retainer and Service Fees.”

Bank Information

Bank Name

Bank Routing Number

Bank Account Number

Name on Account

Address on Account

Client Authorization: I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify OCCAMS in writing of any changes in the account information or termination of this authorization at least 10 calendar days prior to the next billing date. If an ACH Transaction is rejected for Non-Sufficient Funds (NSF) I understand that OCCAMS may at its discretion attempt to process the charge again within 30 calendar days and I agree to an additional NSF charge of up to $25 for each attempted and returned NSF and $40 for each unauthorized return, which will be initiated as a separate transaction from the authorized payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I wish for the ACH transactions to take place as stipulated in Appendix C.

I certify that I am a signatory of this bank account and will not dispute the transactions with the DEPOSITORY or OCCAMS; so long as the transactions correspond to the terms indicated in this authorization form.