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Membership Registration Form

Automatic Checking Deduction

For easier processing, please include a voided check with this application

I hereby authorize UCOF, Inc. hereafter to initialize debit entries to my checking account indicated below at the depository named Executive National Bank, to debit the amount of $30.00 a month to such account on or about the 1st of each month. This authorization is to remain in full force and effective, until U.C.O.F., Inc. has received written notification from me of its termination in such time and such manner to afford U.C.O.F Inc. and the depository a reasonable opportunity to act on it.

Thank You For Your Membership

Additional Payment Plans:

Please bill me Monthly for $30.00
Please bill me Quarterly for $90.00
Please bill me Bi-Annually for $180.00
Please bill me Annually for $360.00

(Billing Full Amount must be paid up front in order to activate billing system)

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