I (we) hereby authorize Inner Sanctum Access, NEA, Inc., herinafter called ISA, to initiate debit entries to my (our) ( ) Checking ( ) Savings account (check one) for my monthly Internet services account by charging each payment to my bank account and to make that deduction payable to the order of Inner Sanctum Access, NEA, Inc. I agree that each payment shall be the same as if it were personally signed by me. This authority is to remain in effect until revoked by me in writing. In addition, I have the right to stop payment of a charge by timely notification to my Financial Institution and ISA. ISA reserves the right to terminate this payment plan or my participation therein if services are cancelled.
Please return this completed authorization form and a VOIDED check from the appropriate account to: