<b>Auto Debit to Credit Card or Debit Card</b>
I authorize USWC Premium Finance Company to make the /Debit Card applicable number of consecutive monthly charges to my credit card or debit card, in the amounts and at the times disclosed on the premium finance agreement.

This authority remains in effect until USWC Premium Finance Company has received written notification of termination from customer in time to allow reasonable opportunity to act on it or until the final installment payment has been paid.