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AUTHORIZATION FOR ACH DIRECT PAYMENTS TO PHILIPPS SWIM CLUB

(ACH DEBITS)

Merchant Information

Name: Philipps Swim Club

Address: PO Box 58054

City, State Zip: Cincinnati, Ohio 45258-0054

Phone: 471-2280

RE: ACH Authorization

In consideration of the goods, products and/or services provided to me by MERCHANT, as listed above, I hereby authorize MERCHANT to initiate a debit entry to my checking account indicated below at the depository financial institution named below, hereinafter called DEPOSITORY, and to debit the same to such account for the amount listed below. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.

Depository Bank Name: Branch (City, State, Zip):

_________________________________________ ________________________________________

Checking Account Number (No Savings Accounts): Routing Number:

_________________________________________ ________________________________________

Amount: $________________________________

Effective Date: Due the 28th of Each Month for Four Months beginning February 28, 2012

This authorization is to remain in full force and effect for this transaction only, or until such time that my indebtedness to MERCHANT for the amount listed above is fully satisfied. The specific debit to my account authorized herein may only post on or after the EFFECTIVE DATE listed above, and in no event may the debit transaction post to my account prior to said date.

I may only revoke this authorization by contacting MERCHANT directly at the address and phone number listed above, and only in the case that I return the good, product and/or service provided to me by MERCHANT pursuant to their particular return policy in effect the date this authorization is granted.

Name:____________________________________ Date:___________________________________

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Signature:_________________________________