Correspondent Bank Name (or BIC code) ABA number (9 digits) :

1. Important notice: Any new customer joining the SWIFT Services is required to register to the direct debit mechanism for the payment of all its SWIFT invoices. PREAUTHORIZED DEBIT PAYMENT - AUTHORIZATION AGREEMENT PREAUTHORISED DEBIT PAYMENT - AUTHORISATION AGREEMENT UNITED STATES 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 USD 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. Authorisation Authorised signature : Name : Title : Date : Authorisation Authorised signature : Name : Title : Date : Please indicate below the details of your USD account in the United States. Correspondent Bank Name (or BIC code) ABA number (9 digits) : Bank Account number: Person/Dept. we may contact for possible questions: 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 16