This authorizes Silver Lake Resort & Campground to send debit entries (and appropriate credit
and adjustment entries) electronically to my (our) account as indicated on our originally signed
authorization. This authorizes the financial institution holding the Account to post all such
entries.

Unless otherwise indicated, Silver Lake Resort & Campground will withdraw the following
amount(s) from the listed account on the listed dates:

• March 15th $700
• April 15th $700
• May 15th $700
• June 15th $700
• July 15th $700

I understand that a 3% fee will be assessed to the amount being charged.

In addition to the monthly lot rent, I would also like the following withdrawn from my account:

Renewal Rent due September 1st in the amount of $900Off-site, Back-In parking fee of $300 on March 15thOff-site, Pull-Through/Larger Back In (both in gated area) parking fee of $350 on March 15thOther: (please be specific)

This authorization will be in effect until Silver Lake Resort & Campground receives a written
termination notice from myself and has a reasonable opportunity to act on it. I understand that if
I renew my yearly contract, I will need to sign an updated authorization.

Credit Card Information:
I certify that I have utilized the direct payment option in the past, and my information has not changed.

If you have never used the Direct Payment option and would like to do so, please provide:
The name on the credit card: 
Account number:
Expiration Date:
Security Code: