Auto Pay Form

Store Location * Clearfield UT - 678 State St.Ogden UT - 12th StreetRichfield UT - 770 S. Main St.Vernal UT - 1180 N. Vernal Ave.West Valley City UT - 4051 Redwood RdWest Jordan UT - 7800 SouthSt. George UT - 231 St George BlvdPocatello ID - 2215 Garrett Way

Customer's EZ Furniture account number *

This can be given to you by a store employee

Card Type * VISAMasterCardAmerican ExpressOther Card Type

First Name on the Card *

The person paying on account must match this form's information or it will not be accepted.

Last Name on the Card *

The person paying on account must match this form's information or it will not be accepted.

Last 4 digits of the card *

Expiration Date of the card (mm/yy) *

Zip Code of the card's billing address *

Automatic Payment Schedule *

Weekly - on Saturday

Semi Monthly - on the 5th and 20th

Monthly - on the 5th

Monthly - on the 20th

OtherOther

Automatic Payment Amount *

Signature of the cardholder *

Clear

If you are human, leave this field blank.

By signing and submitting this form you are authorizing EZ II Rent To Own Inc., dba EZ II Rent To Own and EZ Furniture Sales and Leasing to make automatic payments on my account as detailed above. In the case a payment does not process successfully, I understand that additional fees will be incurred on this account per the Rental Purchase Agreement, and I authorize EZ II Rent To Own to continue to attempt processing the automatic payment until the full payment has been made. I understand that account will need to be paid to the current set due date as outlined in the Rental Purchase Agreement. I understand that I may update or cancel this Automatic Billing Authorization at any time by contacting the store in-person at least one business day before the payment is scheduled to be billed.

Credit Card On File Form

Store Location * Clearfield UT - 678 State St.Ogden UT - 12th StreetVernal UT - 1180 Vernal AveWest Valley City UT - 4051 Redwood RdWest Jordan UT - 7800 SouthRichfield UT - 770 S. Main St.St. George UT - 231 St George BlvdPocatello ID - 2215 Garrett Way

Customer's EZ Furniture account number *

This can be given to you by a store employee

Card Type * VISAMasterCardAmerican ExpressOther Card Type

First Name on the Card *

The person paying on account must match this form's information or it will not be accepted.

Last Name on the Card *

The person paying on account must match this form's information or it will not be accepted.

Last 4 digits of the card *

Expiration Date of the card (mm/yy) *

Zip Code of the card's billing address *

Signature *

Clear

If you are human, leave this field blank.

By signing and submitting this form you are authorizing EZ II Rent To Own Inc. to charge my card above for the agreed upon purchases. I understand that my information will be saved on file for future transactions on my account. To process a payment using this saved information, I must authorize this transaction by contacting EZ II Rent To Own Inc. in-store or over the phone. You may cancel this authorization and remove the store payment method at any time in-store. This authorization will remain in effect until cancelled.