Automatic Payment Authorization. Effective as of [___________________], ALTO NEUROSCIENCE, INC., a Delaware corporation (“Borrower Representative”) hereby authorizes K2 HEALTHVENTURES LLC (“K2”), or any affiliate acting on its behalf pursuant to the Loan Agreement and the bank or financial institution named below (“Bank”) to automatically debit through the Automatic Clearing House (ACH) from, and initiate variable debit and/or credit entries to, the deposit, checking or savings accounts as designated below maintained in the name of a Borrower, and to cause electronic funds transfers to an account of K2 to be applied to the payment of any and all amounts due under the Loan and Security Agreement, dated December 16, 2022 (as amended, restated, supplemented or otherwise modified, from time to time, the “Agreement”), among Borrower Representative, and any other borrowers party thereto from time to time, K2, and any other lender from time to time party thereto (collectively, “Lenders”), and Ankura Trust Company, LLC, as collateral agent for Lenders, including without limitation, principal, interest, fees, expenses and charges (including Lender Expenses). Capitalized terms not otherwise defined herein, have the meanings given in the Agreement. This Authorization shall remain in effect until the Loan Agreement has been terminated. Bank: Address: ABA Number: Account Number: Account Holder: This Authorization is executed as of the date set forth above by the undersigned authorized representative of Borrower Representative: ALTO NEUROSCIENCE, INC. By: Name: Title: EXHIBIT G FORM OF SECURED PROMISSORY NOTE [[THE SECURITY REPRESENTED BY THIS NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, OR APPLICABLE STATE SECURITIES LAWS. THIS SECURITY MAY NOT BE SOLD, TRANSFERRED OR ASSIGNED, PLEDGED, HYPOTHECATED OR OTHERWISE DISPOSED OF IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT FOR THE SECURITIES UNDER SAID ACT, OR PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER SAID ACT INCLUDING, WITHOUT LIMITATION, PURSUANT TO RULE 144 UNDER SAID ACT.]] $[ ] [ , 20 ] FOR VALUE RECEIVED, the undersigned, [ ], a [ ] (“Borrower Representative”), and each Person party thereto as a borrower from time to time (collectively, “Borrowers”, and each, a “Borrower”), hereby unconditionally, jointly and severally, promise to pay to [ ] (together with its successors and assigns, the “Holder”) at the times, in the amounts and at the address set forth in the Loan and Security Agreement, dated as of December 16, 2...
Automatic Payment Authorization. Borrower authorizes the Lender to make automatic deductions (“Auto Debit”) from the following deposit account (the “Account”) maintained by Borrower at Lender’s offices in order to pay, when and as due, all installment payments of interest, and/or principal, renewal, modification or other fees or payments (a “Payment”) that Borrower is required or obligated to pay Lender under the Note: Account No: Without limiting any of the terms of the Loan Documents, Borrower acknowledges and agrees that if Borrower defaults in its obligation to make a Payment because the collected funds in the Account are insufficient to make such Payment in full on the date that such Payment is due, then Borrower shall be responsible for all late payment charges and other consequences of such default by Borrower under the terms of the Loan Documents.
Automatic Payment Authorization. The “Automatic Payment Authorization” section of Exhibit A of the Loan Agreement is hereby amended to provide that automatic Payments from Borrower’s Account shall include renewal or modification fees or other fees and payments due and owing by Borrower to Lender under the Loan Documents.
Automatic Payment Authorization. Administrative Agent, on behalf of Lenders, may initiate debit entries to any Deposit Accounts as authorized on the Automatic Payment Authorization for principal and interest payments or any other Obligations when due. These debits shall not constitute a set-off. If the ACH payment arrangement is terminated for any reason, Borrowers shall make all payments due hereunder at the applicable address specified in Section 10, or as otherwise notified by Administrative Agent in writing.
Automatic Payment Authorization. Borrower authorizes Lender to make automatic deductions (“Auto Debit”) from the following deposit account (the “Account”) maintained by Borrower at Lender’s offices in order to pay, when and as due, all installment payments of interest, and/or principal, renewal, modification or other fees or payments (a “Payment”) that Borrower is required or obligated to pay Lender under the Loan Documents provided, that Lender shall notify Borrower of any amounts automatically deducted from Borrower’s Account (which notice may be delivered concurrently with any Auto Debit), and provided, further, that no Auto Debit shall be effected for any fees or payments that are not scheduled unless Borrower shall have received, prior to the making of the Auto Debit, a written invoice, which may be delivered via email, detailing the fees or payments that are due: Account No: Without limiting any of the terms of the Loan Documents, Borrower acknowledges and agrees that if Borrower defaults in its obligation to make a Payment because the collected funds in the Account are insufficient to make such Payment in full on the date that such Payment is due, then Borrower shall be responsible for all late payment charges and other consequences of such default by Borrower under the terms of the Loan Documents.
Automatic Payment Authorization. Merchant authorizes DotCom to initiate automatic transfer of funds or debit from your credit account sufficient funds to pay Dotcom’s monthly invoice and for all services provided under this Agreement. Merchant will sign the Automatic Payment Authorization in Exhibit B, attached hereto.
Automatic Payment Authorization. By signing this Membership Agreement you agree that: (1) to the best of your knowledge everything you state on this Membership Agreement is accurate; (2) OSR may retain this Membership Agreement whether or not it is approved; (3) OSR is authorized to check your references and your credit employment history, to verify any information you have provided, and to answer any inquiries about credit experience with you; (4) OSR is authorized to order a consumer report about you in connection with this Membership Agreement, updates and renewals of this Membership Agreement, and any further extension of credit; and (5) OSR has the right to charge to the credit card listed in this Membership Agreement any amounts due to OSR more than sixty (60) days. The undersigned states that he/she has read and understands the Terms and Conditions of the Membership Agreement and agrees to be bound by such Terms and Conditions, and acknowledges that he/she has received a copy of this Membership Agreement. The term of this Membership Agreement is stated above. This contract will renew automatically on a month-to- month basis, without notice on the “Anniversary Date,” unless written notice of cancellation is received by either you or OSR at least thirty (30) days prior to the anniversary date. The notice must be dated, signed and sent certified mail. There is a $25.00 fee for returned checks. No refund will be offered once draft has been taken without notification of cancellation. Please initial in the box that you have read and understand the payment terms: Payment Date: 1st Amount: $ Credit Card* Bank Draft* Name on Card: Bank Name: Credit Card # City: Exp. V-code # Routing # Acct # Visa MasterCard Discover Please attach a cancelled check Signature Date Printed Name PARTICIPATION AGREEMENT Thank you for choosing OSR Physical Therapy as your Aftercare, Health, Wellness, Fitness and/or Pilates Provider. It is our policy to be as accommodating as possible for you, the client, to schedule your sessions. Consistent attendance allows you and your trainer to progress, which will result in moving towards results and outcomes for your goals. In the event that you are unable to make one of your appointments, please call our office in advance. We will help you reschedule your appointment. OSR reserves the right to substitute similarly qualified provider if needed due to scheduling issues or unforeseen circumstances. Aftercare, Health, Wellness, Fitness and/or Pilates sessions may be scheduled...
Automatic Payment Authorization. You authorize us to initiate, on each Payment Due Date, an automatic electronic debit from your Business Payment Account or Bank Account, as appropriate, in the amount of the Total Minimum Monthly Payment; provided, however, that if a Payment Due Date falls on a Saturday, Sunday or holiday, then the debit may be initiated on the next business day. Any separate payments that you make on or before a Payment Due Date will not affect this authorization. You understand that your Total Minimum Monthly Payment may vary from time to time but will in no event exceed the total outstanding Loans. We will not be liable for any fees or Costs that you may incur if we are unable to debit your Total Minimum Monthly Payment under this authorization. We also are not responsible for any fees imposed on you by the provider of any Business Payment Account or Bank Account as the result of any authorized debit or any payments made directly by you under this Agreement. Automated Clearing House transactions must comply with the provisions of U.S. law.
Automatic Payment Authorization. Borrower authorizes Bank to make automatic deductions from the following deposit account (“Borrower’s Account”) maintained by Borrower at Bank’s offices in order to pay, when and as due, all of the regularly scheduled installment payments of interest, principal, or both principal and interest (an “Automatic Payment”) that Borrower is required or obligated to make under the Note: Account No: 96600700608 Bank agrees to provide Borrower with ten (10) days prior written notice before making any such automatic deductions.
Automatic Payment Authorization. I (we) authorize my (our) bank to make my (our) payment to Pinnacle Security, Inc. by Electronic Funds Transfer (EFT) and post it to my (our) account. I (we) understand that I (we) am (are) in full control of my (our) payment, and if at any time I (we) decide to discontinue, I (we) will write the above named Company, and I (we) understand the terms listed below. BANK NAME: ---------------------------------------------------------------- ABA CHECK ROUTING #: ------------------------------------------------------- (First nine-digit number in lower left corner of check) CHECKING ACCOUNT #: ------------------------------------------------------- (Please attach Voided Check) VISA/MC: ------------------------------------------------------------------- EXPIRATION DATE: ----------------------------------------------------------- Pinnacle Security, Inc. is authorized to effect payment monthly beginning one month from the date of this agreement for any amounts owing on my (our)Pinnacle Security. Inc. account, as such amounts become due by initiating debit entries to my (our) accounts indicated at the financial institution named above. Customer agrees and authorizes Company or its agent to debit any return check and/or its charges from the account shown above via the ACH network and/or paper draft without prior notice to the customer of the transaction. I (we) authorize the financial institution to accept any debit entries initiated by Pinnacle Security, Inc. to be debited from the account. After the account has been charged, I (we) have the right to have the amount of an erroneous debit immediately credited to my (our) account by the financial institution up to 15 days following issuance of statement or forty-five (45) days after the account is charged, whichever comes first. (Initial Here) --------------------
