MFI    Mississippi Fijis, Inc.

Print this form, fill it out, attach a "VOIDED" check, and mail to:

MSFiji Treasurer - Draft
P.O. Box 1848
Starkville, MS 39760

Pre - Authorized Draft Order Form

Account Drafting Organization
Name
Mississippi Fiji Inc. 
Street
P.O. Box 1848 
City State Zip
Starkville  MS  39760 
Information from Person Being Drafted
Your Name Monthly Draft Amount
______________________________________________ _______________
Street
Start Drafting On The Date Below: 
Month Day Year
______________________________________________ __________ __________ __________
City State Zip
__________________________ __________________________ __________________________
Bank Information:  The bank account you want drafted
Bank Name
______________________________________________
Bank Street
______________________________________________
City State Zip
__________________________ __________________________ __________________________
Financial Institution Routing Transit Number Customer Account Number
Included on Attached Voided Check  Included on Attached Voided Check 

               Your Signature

I _______________________ agree to allow MSFiji Inc. to draft my account each month beginning on the date specified above for the amount specified above.

ATTACH A VOIDED CHECK TO THIS PAGE if deducting from checking account

If credit card, please include the following:

Credit Card Number _______________________________________________________

Expiration Date __________

Name as it appears on card __________________________________________________

Amount __________