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Biller Order Farm .�.s.o CERTIFICATION AND AGREEMENT A. By signing below, the Biller hereby authorizes Invoice Cloud, Inc. ("Invoice Cloud") to initiate and execute debit/credit entries to its checking/deposit account(s) indicated above at the depository financial institution(s) named above and to debit/credit the some such account(s) The Biller acknowledges that the origination of ACH transactions to its account(s) must comply with the provisions of U.S law This authority is to remain in full force and effect until(i) Invoice Cloud has received written notification(by electronic or U.S mail)from the Biller of its revocation in such time and manner as to allow Invoice Cloud a reasonable opportunity to act on it,but not less than 10 business days notice;and (ii) all obligations of the Biller to Invoice Cloud that have arisen under this Agreement and all other agreements have been paid in full.The Biller must also notify Invoice Cloud,in writing, (by electronic or U.S mail) when a change in account number(s) or bank has occurred at which time this authorization shall apply to such new/changed account This notification must be received within 10 business days of change A fee will be charged for any returned ACH debits. B. By signing below,the Biller named (1) has read,agreed to,and acknowledges receipt of the Biller Agreement,Biller T+C and other Order Forms executed by the Biller, and (2) certifies to Invoice Cloud that he/she is authorized to sign this Order Form, (3) certifies that all information and documents submitted in connection with this Order Form are true and complete;(4)authorizes Invoice Cloud or its agent to verify any of the information given, including credit references, and to obtain credit reports (including a spouse if in a community property state), (4) agrees to pay the Monthly Access Fee through the last day of the month following the effective date of termination as provided in the Billing Agreement; (S) agrees that Biller and each transaction submitted will be bound by the Order Form and the Biller Agreement in its entirety; (6) agrees that Biller will submit transactions only in accordance with the information in this Order Form and Biller Agreement and will immediately inform Invoice Cloud, by email (contracts@invoicecloud.com) if any information in this Order Form changes, and (7) the Biller agrees and understands that outstanding sums due and owing to Invoice Cloud.;will be charged daily or monthly and debited from its current depository account Non-sufficient funds for these debits are grounds for a change in fees or termination of this Agreement In the event of non-payment of any sums due,Invoice Cloud reserves the right to withdraw such sums from the current depository account at any time to ensure payment of the some C. Pay by Text,Standard data rates and text messaging rates may apply based on the payer's plan with their mobile phone carrier.Payer can opt out of text messaging at any time with Invoice Cloud.Partial payment or overpayment is not supported.Service fees may apply based on the biller set up with Invoice Cloud. Biller may not use the service for activities that violate any law, statute, ordinance or regulation. D. By signing below,the Biller hereby gives permission to Invoice Cloud to access his/her credit history via Trans Union,Equifax,or other credit- reporting agency. E. The Order Form and the Biller Agreement will become effective only when counter-signed by Invoice Cloud and upon execution by the Biller of such third party agreement required by Invoice Cloud to permit use of the payment function of the Service In WITNESS WHEREOF,the parties hereto have executed this Agreement as of this doy Accepted by biller: Accepted by Invoice Cloud: X. Corporate Officer Printed Name Printed Name Title Title 143