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Stream Energy Customer Account Number

AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED PAYMENTS (ACH RECURRING ENTRY DEBITS)

Stream Energy Lockbox I (we) hereby authorize Steam Energy, hereinafter called COMPANY, to initiate recurring debit entries to my (our) CHECK ONE: checking savings account

indicated below and the depository named below, hereinafter called DEPOSITORY, to debit the same to such account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. YOUR BANK NAME:

CITY:

STATE:

ZIP:

BANK ROUTING TRANSIT/ABA NUMBER:

(Nine digit number at the bottom of the check on the lefthand side)

BANK ACCOUNT NUMBER:

NAME(S):

This authority is to remain in full force and effect until COMPANY has received notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act upon it.

SIGNATURE(S):

DATE:

CUSTOMER ADDRESS:

Stream Georgia Gas SPE LLC (dba Stream Energy) is a registered Natural Gas Marketer with the Public Service Commission of Georgia (Certificate #GM-38). Stream Energy markets its products and services to residential and commercial customers in Georgia.

Return this form, ALONG WITH A VOIDED CHECK, via fax to 1-866-908-7590, or mail it to: Stream Energy P.O. Box 192746 Dallas, TX 75219-8527

INTERNAL USE ONLY CSR Initials:

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