Far West Inc

Shareholder Settlement Trust
Authorization for Direct Deposit

Check one:

Complete all information requested below:

If you do not know this number contact your financial institute. We cannot process direct deposit without this number.
Check one:

By signing below, I certify to Far West Inc. Shareholder Settlement Trust (FWISST) that I am an owner of the bank account listed above. I authorize FWISST, as appropriate, to initiate credit entries to this bank account at the Depository listed above. I further authorize FWISST to initiate debit entries/adjustments for any credit entries FWISST makes in error to this bank account, provided I receive notification with regard to any such debit entries/adjustments. This authority is to remain in full force and effect until FWISST has received my written notification of termination in such time and manner as to afford FWISST and the above Depository a reasonable opportunity to act on it, unless I fail to keep my address updated with FWISST, in which case I understand that direct deposit will be cancelled.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

If you have any questions regarding the completion of this form contact our Anchorage office at (907) 222-7600 Fax number: (907) 276-2581

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