CANCELATION NOTICE: This authorization is to remain in full force and effect until the COMPANY named above has given written notification of its termination.
Depository Financial Institution
I hereby authorize Local Motion, LLC, hereinafter called, to initiate debit and or Credit entries to the checking or savings account indicated in this form. The depository financial institution named, debit the same to such account. I acknowledge that the origination of ACH transactions to my account must comply with provisions of US law.
Note: All written debit authorizations must provide that the debtor may revoke the authorization only by notifying the originator in the manner specified in the Authorization.