JOHN GLENN SANITATION SERVICE, INC  P.O. BOX 683   342 VOYZEY RD  PHILIPSBURG PA 16866

PHONE: 814-342-4166   FAX: 814-342-3619

I (we) authorize John Glenn Sanitation Company, or its Subsidiary, or its affiliate, to initiate entries to my checking or savings account at the financial institution listed below, and if necessary, initiate adjustments for any transactions credited or debited in error. This authorization will remain in effect until John Glenn Sanitation Company, or its subsidiary, or its affiliate or notified by me (us) in writing to cancel the authority in such time as to afford John Glenn Sanitation Company, or its subsidiary, or its affiliate and the financial institution a reasonable opportunity to act on it.

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Name of Financial Institution

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Address of Financial Institution including Branch, City, State & Zip Code

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Signature                                                                                         Date of Authorization

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Name or Names of Authorizing Parties --- PLEASE PRINT

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Address of Authorizing Parties including City, State & Zip Code

John Glenn Sanitation Account Number _____________________________________________

I pay my account   ____________ Monthly (Drafted monthly on the 15^th)

                                  ____________ Quarterly (Drafted on the 15^th of Jan, Apr, July, Oct)

                                  ____________ Bi – Yearly (Drafted the 15^th of Jan, July)

                                  ____________ Yearly (Drafted on the 15^th of Jan)

If the 15^th of the month falls on weekend or holiday, payments will be drafted on the next business day. Regular Payment Amount _____________  If you have any extra charges on your account, the balance will be debited. In order to avoid this, pay for extra charges or special pick-ups before your account is drafted.

Checking or Savings Account Number _____________________________________________

Financial Institution Routing Number ______________________________________________

(This is the number between the l: and :l on the bottom left of your checks.)

Please include a voided check or deposit form with this application.