Enter Personal Informaiton:    
Account No:  *   
First Name:  *  
Last Name:  *  
Address:  *  
City:  *  
State:  *  
Zip:  *  
Phone:  *  
E-Mail:  *  
Description:    Car Payment
Enter Amount:  *  
Convenience Fee:    $8.95
Total Amount:  *  
     I (we) authorize Faithful Auto Finance, Inc. and any of its affiliates to initiate, and my (our) financial institution to honor, an electronic payment in the amount specified. This authorization is for payments described in the related retail installment contract. I (we) further represent and warrant to Faithful Auto Finance, Inc. that the person(s) executing this authorization is (are) an authorized signatory on the account referenced above. Verify your information carefully. Once authorized, payments requested can't be changed or canceled.