Auto Withdraw - Note Servicing Center

Company Name (If Applicable)

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

Routing Number*

Account Number*

Account Type*

Checking Account
Saving Account

Certification*

I (we) hereby authorize Note Servicing Center to initiate debit entries to my (our) account at the Automated Clearing House member bank identified above through the Automated Clearing House network for settlement on the designated date indicated below. I (we) can cancel or change automatic payments by providing Note Servicing Center with written notification of change or cancellation. Requests for changes or cancellations must be received by Note Servicing Center in writing at least three (3) business days in advance of the scheduled payment date. I (we) agree to have sufficient funds in my (our) account to cover the payments as required under my (our) loan documents. If not, the original amount, plus an additional NSF fee, as allowed by law, may be electronically debited from my (our) account. Note Servicing Center may also assess a late charge if I (we) do not subsequently make my (our) payment within the applicable grace period, and I (we) am still liable for the payment, according to my (our) loan documents. I (we) authorize Note Servicing Center to change the amount of my (our) payment as needed if there is an increase or decrease in escrow or optional products amounts. Note that additional escrow payments are not permitted. I (we) understand if corrections are necessary, it may involve adjustment (credit or debit) to my (our) account. An automatic payment transaction that falls on a non-business day will be processed on the following business day. Saturday is not considered a business day for automatic payment purposes. For interest-only loans, I (we) agree that payments may vary if I (we) have made any additional payment that was directly applied to the principal. I (we) acknowledge that the origination of ACH transactions to/from my (our) account must comply with the provisions of U.S. law. All account depositors must sign if more than one signature is required.

Date to Start Withdraw

Day of the Month Funds are to be Deducted*

Amount to be Withdraw

Name

This field is for validation purposes and should be left unchanged.