MVS-Auto-Pay Authorization Form

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

(559) 432-8221

Making your Mid Valley Services Payments just got easier.

Simply enroll for an automatic payment/withdrawal

from your checking or savings account.

Fill out the below authorization form, attach a voided check and you'll be all set.

Electronic payments are the safest way to pay as electronic checks reduce the chance of identity theft by utilizing the Federal Reserve's ACH System. Plus you can avoid late payments as with Auto- Pay enabled your payments will be withdrawn, on time, on the date you specify and you can enjoy knowing your payment has been made.

It's easy (anyone can do it!) & It saves time (nothing to mail!)

You will still receive your monthly bill.

Your paper statements will continue to be mailed to you each month. By using the automatic payment system, you'll still be able to see a history of your past transactions, so there is no downside.
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*
Work Phone Number
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)
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 loan. not to exceed the amount agreed 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*

Clear
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

It's easy (anyone can do it!) & It saves time (nothing to mail!)

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FORM