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YOUR APPROVAL Date : _________________ Stamp Signature :

Important notice s: - Any new customer joining the SWIFT Service is required to register to the direct debit mechanism for the payment of all its SWIFT invoices. - To speed up the activation of your direct debit, please complete the form and request

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YOUR APPROVAL Date : _________________ Stamp Signature :

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  1. Important notices: - Any new customer joining the SWIFT Service is required to register to the direct debit mechanism for the payment of all its SWIFT invoices. - To speed up the activation of your direct debit, please complete the form and request your correspondent bank to stamp and sign for approval prior to returning to SWIFT. PREAUTHORISED DEBIT PAYMENT - AUTHORISATION AGREEMENT (Abbuchungsauftrag für Lastschriften) AUSTRIA This form is drafted in compliance with the Austrian Direct Debit form Customer Name : SWIFT code (BIC or PIC) : Address : City :Country : E-mail: We, hereinafter called Customer, authorise S.W.I.F.T. s.c.r.l., to originate and transmit electronic debit and credit entries in EUR to our account indicated in this agreement. A prenotification will be sent seven days before actual debiting/crediting of bank account (by MT999, fax or mail). Customer understands that a debit entry will only be accepted if sufficient funds are available in Customer’s bank account. In the event an invoice/credit note is not accepted for any reason, the Customer is to notify S.W.I.F.T.s.c.r.l.within 30 days of invoice date by creating a case online or forwarding a mail to collection@swift.com. Customer Bank Account Information Bank Code : (Bankleitzahl) Bank Account Number : Bank Name : Adress : Zip Code : City : Beneficiary S.W.I.F.T. s.c.r.l. Avenue Adèle 1 B-1310 La Hulpe VAT: BE 413.330.856 (Please respect the maximum number of digits) YOUR APPROVAL Date : _________________ Stamp Signature : RESERVED FOR CORRESPONDENT BANK APPROVAL Date : _________________ Stamp Signature : Please return the original form to: S.W.I.F.T. s.c.r.l., Credit and Collection, Avenue Adèle 1, B-1310 La Hulpe, Belgium Telephone: +32 2 655 35 67 - Telefax: +32 2 655 37 43 - SWIFT BIC: SWHQBEBBFIN - Version 5 December 2003 - Page 8

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