withAutopaySave Time

As your partner in protection, we’d like to offer you a

convenient and popular way to pay for your service.

Orkin’s Autopay saves you time by allowing you to

pay for each service automatically from your credit

card or bank check card. It’s just one more solution

from Orkin to help make your life easier.

It’s simple!

■ Complete the authorization coupon below or

call your local branch at the number on the

top of your invoice.

■ Automatic payment will go into effect for your

next service.

■ After each service, your credit card or bank

check card will be debited.

© 2005 Orkin, Inc.

AUTOMATIC PAYMENT AUTHORIZATION

I (we) authorize the credit card company listed below to tender payment to ORKIN Inc., or to its assignee, (Orkin) for services rendered,

when it is charged and to post the payment to our account.

❏ VISA ❏ MC ❏ AMEX ❏ DISCOVER Card Number ____________________________________________________________________

Name (as it appears on the card) _________________________________________________________________ Expiration Date _____________________

Account Number ________________________________________________ Phone Number _______________________________________________

Orkin is authorized to initiate, at such times as the amounts become due, debit entries against the credit card account listed above for

regularly scheduled services performed by Orkin. I (we) authorize the credit card company to accept and debit entries initiated by Orkin to

be debited from the account. I (we) have the right to cancel this automatic payment authorization by submitting to Orkin written notice 30

days in advance of the intended termination of this authorization; however, this authorization will remain in effect until Orkin has received

that written notification of termination. I understand that it is my responsibility to copy or notify the credit card company that this

authorization is being cancelled. Cancellation of the automatic payment authorization does not cancel the pest control service agreement or

my responsibilities thereunder.

Signature _____________________________________________________________________________ Date __________________________________

FOR OFFICE USE ONLY Processed by __________________________________________________ Date Entered ________________________