MVS-Auto-Pay Authorization Form

7644 N. Palm Ave., Fresno, CA 93711-5732

(559) 432-8221 | servicing@mvloans.com

Electronic Funds Transfer (ACH) Authorization
Set up automatic monthly payments from your checking or savings account.

To enroll:
- Complete the authorization form below
- Upload a voided check (or bank verification)
- Select your preferred withdrawal date
How it works:

Your payment will be automatically withdrawn

each month on the date you specify.

Benefits:
- Convenient, automatic payments
- Helps reduce the risk of missed or late payments
- No checks or postage required
- Payments are processed through the ACH (Automated Clearing House) network
Important Information:
- You will continue to receive your monthly statement by mail
- You may review your payment history at any time
- Please allow processing time for enrollment to take effect
ELECTRONIC FUNDS TRANSFER AUTHORIZATION FORM
Name (as it appears on bank account) *

First NameLast Name
MVFS Loan Number #*
Email*
example@example.com
Home/Cell Phone Number*
Format: (000) 000-0000.
Work Phone Number
Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Account Number*
Routing Number*
Bank Name*
Type of account*

CheckingSavingsBusiness Checking
Please debit my account monthly for $*
(amount to be debited)
Withdrawal Date*
(Payments posted after the 10th are subject to a late fee)
Starting on*

MonthDayYear
Date
I hereby authorize a periodic ACH electronic debit to the account designated above to be paid to Mid Valley Services Inc. for monthly payment on the above loan number, not to exceed the amount agreed to by me above.

I further understand that should my bank dishonor my automated payment for insufficient or uncollected funds, the original amount, plus an additional transaction in the amount of the state allowed NSF check fee may be electronically debited from my account. Should I need to revoke this authorization, I may call Mid Valley Services Inc. at least five days before the payment due date, at 559-432-8221.
Authorized Customer Signature*
Date*

MonthDayYear
Date
Attach a voided check *

Cancelof
Or take a picture with your mobile device or web cam.
Should be Empty:

7644 N. Palm Ave., Fresno, CA 93711-5732

(559) 432-8221 | servicing@mvloans.com

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FORM