CLERK OF THE COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO MARYELLEN O'SHAUGHNESSY JOHN O’GRADY CLERK OF COURTS AUTHORIZATION AGREEMENT FOR AUTOMATIC WITHDRAWALS (DEBITS) AND DEPOSITS (CREDITS) FOR ACCEPTANCE OF FAX FILINGS BY THE CLERK OF THE COMMON PLEAS COURT Franklin County Identification Number: 31-6400067 I hereby authorize the Franklin County Common Pleas Court Clerk of Courts to initiate debit and credit entries to and from the firm or law office account indicated below and further authorize the depository identified below to debit and/or credit the same to and from such account. Firm/Attorney Name: __________________________________________________ Business Address: ____________________________________________________ Business Direct Dial Phone Number: ______________________________________ Business Facsimile Number: _____________________________________________ (This number will receive all returned facsimile confirmations of receipt) Contact Person at Business Location: ________________________________________ Depository Name:__________________________ Area/Office:__________________ City: _________________________ State: ____________________ Zip: ___________ Bank Transit/ABA Number: ________________________________________________ Account Number: ________________________________________________________ This authority is to remain in full force and effect until the Clerk has received written notification from this firm or law office of its termination in such time and such manner as to afford the Clerk a reasonable opportunity to act on the withdrawal of authorization. Name(s): _________________________________________________________ (please print) Tax I.D. Number: ____________________________________________________ Signature: ________________________________________ Date: _____________ Note: Please allow 10 days for your fax-filing account to be activated. American LegalNet, Inc. www.FormsWorkflow.com