ACH AUTHORIZATION FORM

I (we) hereby authorize Quality Wood Floors Inc., hereinafter called COMPANY, to initiate credit entries for payment to (our) account indicated below, and the financial institution named below, hereinafter called FINANCIAL INSTITUTION, to credit the same to such account. I (we) acknowledge that the origination of ACH transactions to (our) account must comply with the provisions of U.S. law.

Company Name

Financial Institution

Financial Institution Office

Financial Institution Address

Routing Number

Account Number

This authority is to remain in full force and effect until the COMPANY has received written notification from me (or either of us) of its termination in such time and manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it.

Printed Name of Representative

Representative Title

Your Signature

Today's Date

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