iedt Q Issue a check in the amount of S Reaptenl's Name: Rocipent's MaUng Address. paiBblelo: Account Number: at Receiving Rnn EFTA01402901 Oty/Svmboi/S eeurily; Oly/Syiliol/Socunly: t Statding Authorizstian Q The undEisigned hereby requests that this aulhorization act as a standing euthorizati