Credit/Debit Card Authorization Form

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360 State Street

Credit/Debit Card Authorization Form Authorization Agreement I hereby authorize 360 State Street to initiate automatic payments every day of the month through my account at www.rentpayment.com or through the use of information provided to a member of 360 State Street Management. This agreement will remain in effect until 360 State Street receives a written notice of cancellation from me or until I submit a new payment option. If you have further questions please contact us at 203-672-1783 or [email protected].

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Authorized Signature (Primary):

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Authorized Signature (Joint):

Date:

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