CHECK DRAFT AUTHORIZATION (Please mail to COL Networks, Inc. 705A Wesley Pines Rd, Lumberton, NC 28358) (Attach Voided Check to this Form) Please pay and charge to my account all drafts drawn by COL Networks, Inc. dba Carolina Online to its own order on or around the 10th of every month in the amount of; Please inital the level of service. ____ Unlimited $19.95 minus 10% for a total of $17.95 ____ Unlimited+ $25.00 minus 10% for a total of $22.50 ____ Gold $30.00 minus 10% for a total of $27.00 This authorization will remain in effect until canceled by me in writing, and until you actually receive such notice. I am aware that I must cancel this draft 10 days before my draft date. I agree that you shall be fully protected in honoring any such draft. I also agree that your treatment of each such draft, and your rights in respect to it shall be the same as if it were signed personally by me. Date:________________ Account Number (User ID)____________ Signature:________________________________________________