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DIVISION 249.

REPUBLIC/ALLIED WASTE SERVICES Automatic Blfling Authorlzaffon Agreement


This Agreement is to the terms and conditions stated belou

SER
I (we) hereby

ACCOIINTNT]MBER RBPT]BLIC/ALLIED WASTESERVICES


for the amount or maximumamount due of
(our) bank account as indicated below at institution narned below. I (we) acknowledge ACH h"nsactions to my (our) account m.usl , to either:

fl

tnitiatedebit
the depository that the origination comply with provi

ardfor the amount or maximumamount due

Bank/FinancialI Steet, Apt#

448
Routing Number

carc type:Pvisa
Checking account

flMastercard IAmerican ExpresslDiscover

I Business tr
Savings account nu

Thisauthorization will fromme (or either of


and my financial i

in full forceandeffectuatil REPUBLIC/ALLIED WASTE SERVICES has received written notification of its termination suchtime andin suchmanner to afford REPIJBLICiALLIED WASTE SBRVICES in as
a reasonable opportunity to agt on it.

REPUBLTC/
wdtten notice to The inabilify of

WASTESERVICES
ling address(es) provided above.

reserves right to cancel Agreemont any time upon.the this at

business days'

ALLIED WASTESERVICES to sscure paymgnt from the accounts designated above may resultin temrination termination thisAgreement. of from an account a financielinstitution,in additionto providingnoticeasstatd at Bbove to tD WASTE SERVICES ' you maystoppaynentof a preauthorized elecnonic firnd transfer notis'ing your bankor by financial institutiou accordance theproceduos it hasestablished, wjth that Tormination a preauthorized of eleotronic firnaltansfer doesnot affect your obligation to timely payment REPUBLIC/ALLIED WASTE SERVICES to in someotheracceptable manner, 4. To the extent al by laq tle liability of REPUBLIC/ALLIED WASTE SERVICES in connection Agraement with is limited to the of arryinconectcharge withdrawal, REPIIBLIC/ALLIED WASTB SERVICES or will not be
of services and/or With respect w to
liable for anv other

REPUBLIC/ ALLTEDW
or other
of lfie Agreentent; conhol, including,

hadhrowledgethatsdchdamages might be incuned,REPUBLIC/ SERVICES alsowill notbeliable:(i) for youracts omissions, or includind

WASTESERVICES

whether direct, incidental, special, or consequential, including but not limited to loss of income or profits, whedrer or not rvl! Prv^rN,

(iv) for loss,damage, delaycaused eventsREPIIBLIC/ALLIED W.{,STE SERVICES or by cannot not limited to, actsof God,weather conditions, of public enemies, acts war, srikes, civil commotions, actsof public or authorities with or apparent authority. 5. This Agreement becomeeffectivewith the next billing cycle following the date statedbeloiv,upon approvalin writing by Customerand an wil authorized of REPUBLIC/ALLIED WASTE SERVICES This $.greement does lrot go into effect until approved in writiugby ALLIED WASTESERVICES DATED

REPTJBLIC/ALLIED ASTESERVICES REPIIBLIC/ALLIED ASTESERVICES


by:

ALnHoRIzATIoN

Phone

J-

O*3Zf

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Please attach a voidedcopy of your checkor your ssvingsaccountdepositslip.