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., . • : <br /> � <br /> ����� ���r� . <br /> PAYMENT A THORIZATIC)N FORM I� <br /> U <br /> LOAN AMOUNT: �7�rjQQ.QQ LOAN NUMBER:2340199006 <br /> DATE: January 13,2016 NOT VALID AFfER:May 11,2016 <br /> BY SIGNING BELOW, INVE [THE BORROWER(S)]: , <br /> 1. Acknowledge receipt of the Note & Disclosure Statement (the "Note") bearing the same loan <br /> number referenced at the top of this form for my loan with EnerBank USA and agree to be <br /> legally bound by the terms and conditions of the Note. <br /> 2. Confirm that there has been satisfactory delivery of all equipment, goods and/or services by <br /> the Contractor, and if any installation was included in the contract, there has been satisfactory <br /> completion of such installation. <br /> 3. Represent and warrant that the loan proceeds will be used only as set forth in the Note. <br /> 4. Instruct EnerBank USA to disburse to Contractor the proceeds of this loan in the amount of • <br /> ' Seven Thousand Five Hundred Dollars &Zero Cents. <br /> Borrower Date <br /> Judfth A Hudson <br /> Borrower Date AUTH�RIZATION NUMBER: 13355911 <br /> John E Hudson <br /> BY SIGNING BELOW, CONTRACTOR REPRESENTS AND WARRANTS TO ENERBANK USA: <br /> 1. Contractor has delivered all equipment, goods and/or services and completed any installation <br /> included in the contract to the satisfaction of the Borrower(s). <br /> 2. Contractor has positively identified each Borrower whose signature appears above. <br /> 3. This Payment Authorization Form has been signed by a duly authorized representative of <br /> ontractor. <br /> Contractor Date <br /> S Air Conditioning,Heating(Refrig <br /> 2.99%10-Yr Loan <br /> 1245 Brickyard Road, Suite 600,Salt Lake City, UT 84106 <br /> 1-3000-1 Rev.3/13I15 <br /> � <br />