I authorize CancelledA Way Forward Inc to initiate, and my financial institution to honor, a one-time electronic debit from my account on the date, for the amount, and from the account listed.

I authorize CancelledA Way Forward Inc to store and initiate electronic payments from my indicated account, and authorize my financial institution to honor such payments. This authority is for the amount and dates listed, and is to remain in effect until canceled by CancelledA Way Forward Inc , my financial institution, or me. I can cancel my authorization for recurring payments by contacting CancelledA Way Forward Inc at . I also confirm that this constitutes my written authorization/signature to enroll in recurring payments, and to store my account information on file for future transactions.