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You are agreeing to pay $ plus a Fee of $ (%) for a Total of $.

Date	Payment ($)	Fee ($)	Total ($)

Number of Payments: 0

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I authorize Eastpoint Recovery Group Inc. to process the above payment of $. I also authorize Eastpoint Recovery Group Inc. to store this information in compliance with payment processing regulations and to charge the card listed above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact Eastpoint Recovery Group Inc. prior to the payment date.

I authorize Eastpoint Recovery Group Inc. to process the payments as outlined in the payment schedule. I also authorize Eastpoint Recovery Group Inc. to store this information in compliance with payment processing regulations and to charge the card above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact Eastpoint Recovery Group Inc. prior to the payment date.

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