APS PAYMENT

AUTHORIZATION FOR AUTOMATED PAYMENTS

I authorize and request Rcmc medical center to initiate debit entries to my account, by and through automated payment systems, here, in after called APS, and to debit the same to such account as indicated below at the depository financial institution indicated below. This authorization is to remain in full force and effect until APS has received written notification from me. It’s termination and such time and matter, as to afford APS, and depository financial institution a reasonable opportunity to act on it