COMPANY INFORMATION

Company Name

Company Federal ID Number

interLink Hawaii Inc. 99-0319794
Company Contact Phone Number Fax Number Effective Date
David Rodman 808-334-4000 808-326-9545 %EFFDATE%

ACH FILE INFORMATION

Transmission Date Debit Item Count Total Debit Amount
%DATE% %DEBCOUNT% %TOTALDEB%
File Record Count Credit Item Count Total Credit Amount
%RECCOUNT% %CREDCOUNT% %TOTALCRED%

AUTHORIZED COMPANY SIGNATURE DATE

%DATE%

FOR BANK USE ONLY
Received by: Date:

Faxed

Verified by: Time: