DIRECT DEPOSIT AUTHORIZATION AGREEMENT (ACH CREDITS)

COMPANY NAME: TOWN OF MILFORD                COMPANY ID#: 04-6001224

I (we) hereby authorize the Town of Milford to initiate credit entries and to initiate if necessary, debit entries and adjustments for any credit entries in error to my (our)  [    ]  Checking or [    ] Savings

Account indicated below and the depository named below to credit and/or debit the same to such account.

**PRIMARY DIRECT DEPOSIT ACCOUNT

Bank Name:_______________________________

Branch:___________________________

City:___________________  State:________     Zip:_____________

Routing #:________________________________

Account #:__________________________________

**ADDITIONAL ACCOUNTS

Bank Name:___________________                         Bank Name:_____________________

Routing #:_____________________                       Routing #:_______________________

Account #:______________________                   Account #:_______________________

Amount of Deposit: $_____________                      Amount of Deposit:  $______________

[    ]  Checking or   [    ] Savings                                          [    ]  Checking or   [    ]  Savings

Bank Name:___________________                         Bank Name:_____________________

Routing #:_____________________                       Routing #:_______________________

Account #:______________________                   Account #:_______________________

Amount of Deposit: $_____________                      Amount of Deposit:  $______________

[    ]  Checking or   [    ] Savings                                          [    ]  Checking or   [    ]  Savings

This authorization is to remain in full force and effect until the Town of Milford has received written notification from me (or us) of its termination in such time and manner as to afford the Town of Milford and participating bank a reasonable opportunity to act on it.

Name(s):________________________________________  Social Security #:__________________

Signed: _______________________________________Date:  __________________

(  ATTACH A VOIDED CHECK FOR EACH CHECKING ACCOUNT LISTED )