Checking/Draft User Authorization

Internet Services of New England
PO Box 1744
Merrimack, NH 03054
+1 603 424 5278  	Dialin: +1 603 424 6675   Fax: +1 603 424 9977	
E-MAIL:  admin@isone.com		

Check/Draft Printing Release

Welcome!  We are glad you chose INTERNET SERVICES of NEW ENGLAND as your internet 
services provider.  This form is required to authorize ISONE to printed and deposit 
checks/drafts drawn on your bank account WITHOUT your signature.  Checks/drafts will 
be printed and deposited on or about the 2nd of every month in which your account(s) 
have incurred charges.  You may restrict the amount of the automatic checks by checking 
the box so marked below and initialing the line.

I, the undersigned, hereby authorize Internet Services of New England (ISONE) to print 
and deposit negotiable instruments drawn on my checking/NOW account using the information 
entered below.  These checks/drafts will be printed and deposited on or around the 2nd of 
every month in which your internet account(s) have incurred charges.  If you have multiple 
accounts, multiple checks/drafts might be printed up to the amount of incurred charges.

Internet Services of New England is in no way responsible for any check/draft returned 
unpaid or any check/draft not printed.  The full balance and all charges are your 
responsibility.  Any checks/drafts returned to ISONE will be charged back to your
account(s) and a return check processing fee will be added.

This service is intended as a convenience for our subscribers.  If multiple checks/drafts 
are returned, ISONE reserves the right to cancel this agreement with you.   This authorization 
will remain in effect until either: we cancel it, you cancel it in WRITING at least 10 days 
before the end of a month, or you close your internet account, at which time, ISONE reserves 
the right to bill your FINAL bill to a check draft. If you change your bank account, let us 
know 10 DAYS BEFORE THE END OF THE MONTH.

If requested, you will still receive a monthly statement showing charges and the checks/drafts 
printed as a credit. You will receive an e-mail on or about the 3rd detailing charges.  You 
will always receive a statement if you have a non-zero balance.  You may limit the maximum 
amount we can print by completing that section below.


   Accountholder information:

   Signer Name (Please Print): ____________________________
   Bank or Credit Union name:  ____________________________  Account# _____________

   I  ___ Would  ___ Would NOT  like to receive monthly statements by email.

   Signer Signature: ______________________________________________________________

   Monthly Maximum Amount allowed: ______________________  Initials: ______
                (Your total monthly bill will be printed if this is not entered)

   PLEASE ENCLOSE A CHECK/DRAFT FROM YOUR ACCOUNT MARKED 'VOID'