EFTA00313944.pdf

California Cryobank Specimen Storage Agreement `I" Klink- 3 ‘uro„ Lnk. pa‘itx.n, vuoincii_won By signing this Automatic PayMeet ALthonistion bclo‘‘. hereby autiont: CaIltorma Cr> oSank l LC i -Cryobaak") to automatically charge the credit card that you have pros akd the Monthly Storage Fee for those services provided to you pursuant to the Specimen Storage Agreement (Acct No: 1 (the 'Agreement") A summary of certain tams and conditions is set out below. Please see the Aars min for more information . What 6 the AlibO)illik Payment' Cryobank will automatically charge the credit card that you have provided on a monthly basis the then-current Monthly Storage Fee The Monthly Storage Fee is charged in advance for those sonices that Cryobank provides to you relating to the storage of your specimens When the Automatic Payments Begin The automatic payment of Monthly Storage Fees will begin in one of two ways: (I)i( you have pre-paid for storage. the automatic monthly payment will begin on the conclusion of the Pre-paid Storage Period. and (21 if you have not pre-paid for storage. the automatic monthly payment will begin upon the necution of the Agreement. 3. The Monthly Storage Fee. Am oant and Changes Cryobank will automatically charge your credit card the Monthly Storage Fee that it generally charges to its other customers. Cmobank resents the right to change the Monthly Storage Fee at any time. If Cryobank changes the Monthly Storage Fee. it will send you written adtICC sit regular mail and email approximately thiny (30) days in adsance of die change. 4. How Long the Automatic Payments Conduce The automate payment of the Monthly Storage Fee will continue monthly' until you either termmatc the Agreement or enrollre-enrull in the pre-pad storage option. 5. How to Cancel Automatic Payments by Terminating the Agreement. The Agreement sets out how it cat be RI-mutated Please note that. to terminate the Agreement you must submit the Specimen Storage Dmeontinuanon Ram (the "Discontinuation Form"; pursuant to the instructions included in the Discontinuation Form You can request the Discontinuation Form by calling Cmobank's corporate headquarters s sa telephone at 866-927-9622. or by requesting a copy of a via email at by contacting the Cryobank at in pawn z any of the Cryobank locations 6. How to Stipend Automatic Payments by Fnmlling in Pre-Paid Storage You can suspend the =toms,: payment option by enrollinge-enrolling in the pre-paid storage option You an enroll or rcenroll in the pre-paid storage option by canactmg the Cmobank Please mac that. once the new Pre-paid Storage Period ends, Cryobank will resume the automatic payments as to out in No. 2 above_ 7. Your Obligations. You acknowledge and agree that: (I) you will notify Cryobank in writing of any changes to your billing information at least thirty (30) days prior to the neat billing date, and (2) you are the authorized limier of the provided credit card. Acknowledged and agreed by: Name: 7- aM NJ Signature: Date: California ( t CB . Proursetar tkeument. t nautleorlird Laic or distribution I about pits CCB consent is prohibited. R(P-CDP-F007 LI Page 8 of 8 EFTA00313944