AUTOMATIC PAYMENTS AUTHORIZATION FORM
(Print this page, fill out and return to address below.)


RETAIN FOR YOUR RECORDS


On (date) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I authorized (name of financial institution) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ to initiate variable entries to my checking account, drafts or electronic transactions payable to Santel Internet, dba Santel Communications Cooperative, and agreed to the terms listed on the authorization.

Santel Internet, dba Santel Communications Cooperative, agrees that it will indemnify and hold you harmless for any loss as a consequence of your actions resulting from or in connection with the execution and issuance of any check, draft, or order, whether or not genuine purporting to be executed or issued by or on behalf of Santel Internet, dba Santel Communications Cooperative, and received by you in the regular course of business for the purpose of payment, including any cost or expenses reasonably incurred in connection therewith.

(Detach here and return lower portion to Santel Internet)

AUTHORIZATION FOR AUTOMATIC PAYMENTS


I authorize Santel Internet, dba Santel Communications Cooperative, and the financial institution named below to initiate variable entries to my checking account. This authority will remain in effect until I notify you in writing to cancel it in such terms as to afford Santel Internet, dba Santel Communications Cooperative, opportunity to act on it. I authorize scheduled payments to be made from my checking account between the 15th and 20th of each month.

__________________________________________________________
NAME OF FINANCIAL INSTITUTION

__________________________________________________________
ADDRESS OF FINANCIAL INSTITUTION

__________________________________________________________
DATE

__________________________________________________________
SIGNATURE

__________________________________________________________
NAME (PLEASE PRINT)

__________________________________________________________
ADDRESS (PLEASE PRINT)

__________________________________________________________
PHONE NUMBER

CHECKING ACCOUNT NUMBER __________________________________

EFFECTIVE DATE FOR AUTOMATIC PAYMENTS ____________________

__________________________________________________________
BANK ROUTING NUMBER
(Shown between the symbols on the bottom left hand side of your check. Please furnish us with a voided check.)

Return to:

Santel Internet
P.O. Box 67
Woonsocket SD 57385-0067


For more information, call us at 1-888-796-4411