HR SPECIAL MEETING AGENDA 01-14-2019

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AUTOMATIC MONTHLY PAYMENT ENROLLMENT FORM Loan # 2150 Bob Blue 800 Cleveland Av. Deephaven, MN 44070 Automatic Monthly Payment is a practical and easy way to stay on top of your loan and make sure that your monthly payment is always on time. You get to choose a withdrawal date (from 6 predetermined dates), and we will process your monthly payment through your bank account -via ACH- every month on the same date, until your loan is paid in full or you cancel the service. All you need to do is fill the information below, attach a void check to this form, and we will take care of the rest. 1- Bank Account Information for Automatic Payments: Bank Account Information: Bank Name: Routing # (ABA): Bank City: Account Number: Bank State: Name on Account: Type of Account: Checking ⌈ ⌋ Savings ⌈ ⌋ 2- Withdrawal Settings: Withdrawal Information: Please choose 1 of the Available Withdrawal Dates: Monthly Payment Amount:$ 6,500.00 5th of each month 15th of each month Additional to Principal: 10th of each month 20th of each month Total Withdrawal Amount: 25th of each month 30th of each month First Withdrawal Date: I understand that by signing this form and providing this information I authorize Center for Energy and Environment,CEE to initiate an electronic automatic withdrawal from my bank account (via ACH) every month on the date specified above (or the next business day if said date falls on a Saturday, Sunday or a Non-Banking Holiday), until I cancel this authorization in writing or my loan is paid in full. I understand that it is my responsibility to keep enough funds in my account to cover this payment every month (cancellation notice should be received at least 10 business days before the next scheduled automatic withdrawal). And I understand that, if for any reason, my bank refuses to honor any scheduled transactions I am still liable for the payment, and I need to make immediate arrangements with CEE to cover the unpaid installment. In the event of my bank refusing payment of any transaction resulting from this authorization, I agree to be charged a $25.00 Non Sufficient Funds fee for such transaction. I certify that I am the owner or the authorized user of this bank account, and that I will not dispute or recall any of the scheduled transactions through my financial institution, as long as these transactions comply with the terms agreed in this authorization form. Name: Date: Signature: Center for Energy and Environment | 212 Third Avenue North, Suite 560 | Minneapolis, MN 55401 Ph.: 1-855-296-5626 | Fax: 612-455-7805 | www.mncee.org | https://mncee.loanpro.software | loanservicing@mncee.org Form LS003 05/15/2018