Reopienfs Name; Reapenl'sMaiingAddress payable lo; EFTA01403511 Account Number: at BeceivinQ Firm Qty/Symboi/Secumy; Qty/Symboi/Socu riiy; Standitg Authorizatian Q The undeisigned hereby requests that this authoniation act as a standing authorisation. The undersigned understands end agrees that this authonra