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Name:
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Pay To: Chainlink Services LLC Amount: : : 000 Routing Number Account Number Check Number
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Please Verify Your Information

BY CLICKING ON THE SUBMIT PAYMENT BUTTON, I AGREE TO THE TERMS AND CONDITIONS OF USING MY CREDIT OR DEBIT CARD AS A PAYMENT METHOD AND I AUTHORIZE Chainlink Services LLC TO PROCESS A CHARGE FOR THE DOLLAR AMOUNT ENTERED ABOVE.

I hereby authorize Chainlink Services LLC to debit my debit or credit card in the amount specified above as payment to my account with Chainlink Services LLC for a single account, which will be processed pursuant to the terms of Regulation E; Electronic Funds Transfers of the Federal Reserve System.

I hereby electronically consent to and authorize my signature to the funds transfer authorization. I also agree that I am an authorized user of the credit or debit card account that I have provided and am authorized to make payments on this account.

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