E-Check Form

Please fill below.  Please cut and paste the entire content and email to support@fashionsense101.com.

I, _____________________________________, hereby authorize  Pearl Castle

to charge my Bank Account in the amount of $____________

Account # _______________________________________

Account Routing # _______________________________________

Bank Name # _______________________________________

Checking/Saving Account Billing Address

Street: ______________________________________________________________________

City: _____________________________, State: ________ Zip Code: _________________

Telephone: ________________________________

As the account holder, I hereby authorize the above charge.

Account Holder Name _________________________________ Date _________________