EFTA00283801

- • • Credit or Debit Card Authorization Form (One Time Payment Only) Property Name ("Landlor. NI\tu6 Resident/Applicant Name Property Address ('teased Premises,: Unit # W a(L,,C) O XIS by authorize and agree to allow Aspen Square Management, Inc., on behalf of the Landlord, to charge / MasterCard / Debit (CIRCLE ONE). Name on Credit/Debit Card Address City State Zip Credit/Debit Card Number Expiration Date Amount s w -.°73) Reason for Payment Signed this J day of Ni 2011 Resident/Applicant: T anfilord / Landlord's Agent: ASPENSQUARE •CAn•GSvtki -cox \:act EFTA00283801