AUTOMATIC TRANSFER AUTHORIZATION

EXTERNAL/ACH SYSTEM

As a convenience to me/us, I/we hereby authorize SIMMONS FIRST BANK – SEARCY (“Bank”) to perform the transfer(s) listed below:

Customer Name:___________________________________________________ Date:___________________

Address:________________________________________________________ Phone:____________________

Transfer Amount:_________________________________________ Beginning Date:____________________

Frequency:__________ Monthly:___________ Other:____________   Day of Month:____________________

Transfer From:                                                                                      Transfer To:

Bank:  ____________________________________                                Bank:   SIMMONS FIRST BANK_____________

Phone:  ___________________________________                                Phone: 501-268-7575________________________

Routing #:  ________________________________                                 Routing #: _______________________________

Account Name: ____________________________                                  Account Name: Ghana West Africa Missions_____

Account #: ________________________________                                Account #: ________________________________

_______ Checking              _______ Savings                                                _XXX___ Checking            _______ Savings

I/We agree to maintain a sufficient account balance to cover the transfer as specified in this authorization.  If the transfer causes an overdraw in the customers account the Bank may cancel the transaction.  It is also understood that in the event of an error, the Bank has the right to make adjusting entries as needed.  This agreement will remain in effect until revoked in writing by me/us and such notice is received by the Bank in such time to afford the Bank a reasonable opportunity to act on it.  The Bank reserves the right to terminate this agreement at any time and may amend this agreement, in whole or in part, and the amendment shall be binding on the customer.  Any amendment shall become effective 7 days after the Bank provides written notice of the amendment to the customer.

I/We understand that the Bank is providing this service as an accommodation and convenience to the customer.  The Bank shall be held free and harmless from and against any and all claims, demands, actions, suits, whether groundless or otherwise, whether based on contract, negligence or otherwise, and as may arise out of any act or failure to act on the part of the Bank.  The Bank shall incur no liability to the customer or any other person in the event the Bank fails to make the transfer for any reasons.  IN NO EVENT SHALL BANK BE LIABLE FOR ANY CONSEQUENTIAL, SPECIAL, INDIRECT, PUNITIVE OR EXEMPLARY DAMAGES OR LOSSES WHICH THE CUSTOMER MAY INCUR OF SUFFER BY ANY REASON OF THIS AGREEMENT.  Customer shll indemnify Bank for any and all liabilities, losses, damages, costs, charges and other expenses of every nature and description, including attorney fees, which Bank may incur or be subject to which are related to any transfer Bank makes.

I/We understand that any changes in the amount of the transfer must be provided to the Bank in advance in such time to afford the Bank a reasonable opportunity to make said changes.  It is also understood that if the transfer is for the purpose of a loan payment and the amounts change in accordance to the loan agreement, the Bank is authorized to change the transfer amount accordingly.

Signature:              _______________________________        Authorization Accepted:

                                _______________________________        __________________________________________

                                                                                                                                                                                (Bank)

  Termination of Agreement:    The above Automatic Transfer Agreement is hereby terminated:

   _____ By Customer Request                             _____ Bank Terminates Agreement                 Date:_________________

   Customer Signature:_____________________________   Employee: _______________________________

   Customer Signature:_____________________________