Fax to: 800 452-5286

I AUTHORIZE ADAMS, EVENS & ROSS TO PERFORM COLLECTION SERVICES ON ALL ACCOUNTS PLACED FOR COLLECTION.  Adams, Evens & Ross has authorization & is hereby granted limited power of attorney to deposit debtor checks, whether made payable to Client or to Agency, into Agency's trust account and to disburse funds in accordance with the above fee schedule.  It is expressly understood that Agency is authorized to deduct fees owed to them before remitting balance to Client.  PAYMENT MADE DIRECTLY TO CLIENT WILL BE REPORTED TO ADAMS, EVENS & ROSS UPON RECEIPT.  ALL PAYMENTS THAT ARE RECEIVED BEFORE THE 15TH OF THE MONTH WILL BE REMITTED ON THE 5TH OF THE FOLLOWING MONTH ALL PAYMENTS THAT ARE RECEIVED AFTER THE 15TH WILL BE REMITTED ON THE 20TH OF THE FOLLOWING MONTH

Company Name:__________________________________

Signature:           __________________________________

Date:                   __________________