FIFTH THIRD BANK" Application Fee Credit Card Authorization Date October 03, 2014 Mortgage Loan Officer Borrower Name Name on Credit Card Credit Card Type Credit Card Number Expiration Date Amount to be charged Loan Number Joann Brown ❑ Mastercard ❑ Visa Borrower's Authorization Signature R eqter ed Authorization D ate Relationship to Borrower CONFIDENTIAL SIDNY_GM_00030283 EFTA_00140901 EFTA01279835