ACH Authorization Cancellation Request

ACH Authorization Cancellation Request
Loan Number:
Property Address:
Borrower Name:
Co-Borrower Name (if applicable):
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Borrower Verification
To protect your account, August REI may require verification of identity before processing this request.
Borrower Verification Options
ACH Cancellation Request
I/We hereby request cancellation of the Automatic Clearing House (ACH) authorization currently established for the loan referenced above.
Borrower Acknowledgment and Compliance Disclosure
- Cancellation of ACH authorization will stop future automatic withdrawals once the request has been processed.
- Cancellation of ACH does not alter, modify, waive, or satisfy any obligation under the terms of the Note, Mortgage, Deed of Trust, Loan Agreement, or other loan documents.
- Monthly payments remain due according to the terms of the loan.
- It is the borrower's responsibility to ensure payments are made by another approved method after ACH cancellation.
- Requests may require processing time and any payment already scheduled or in process may still be withdrawn.
- Cancellation of ACH authorization does not stop collection activity, default notices, loss mitigation reviews, foreclosure proceedings, bankruptcy actions, legal remedies, or any other servicing activities if the loan is delinquent or otherwise in default.
- Borrowers remain responsible for all amounts due, including principal, interest, escrow advances, fees, and other charges permitted under the loan documents and applicable law.
- August REI reserves all rights and remedies available under the loan documents and applicable federal and state law.
Requested Effective Date:

MonthDayYear
Financial Institution:
Last Four Digits of Account Number:
Reason for Cancellation (Optional)
Reason for Cancellation

Other
Borrower Authorization
Borrower Signature
Date

MonthDayYear
Date
Co-Borrower Signature
Date

MonthDayYear
Date
PLEASE NOTE: ALL CANCELLATION REQUESTS MUST BE SUBMITTED AT LEAST 15 DAYS PRIOR TO THE NEXT SCHEDULED ACH DEBIT DATE TO BE VALID FOR THAT MONTH. IF NOT SUBMITTED AT LEAST 15 DAYS PRIOR TO THE NEXT WITHDRAWAL DATE YOUR REQUEST WILL NOT GO IN EFFECT UNTIL THE FOLLOWING MONTH
Servicer Use Only

Do not fill if you're the borrower.
Date Request Received:

MonthDayYear
Date
Received By:
Verification Method:
Date ACH Cancelled:

MonthDayYear
Date
Processed By:
Comments:
August Real Estate Investments LLC | NMLS#144640 | www.AugustREI.com
P 972-767-9219 | P 844-286-1145 | F 888-475-4103 | Mail: PO Box 496644, Garland, TX 75049-6644 | 3960 Broadway, Suite 107, Garland,
TX 75043
Should be Empty:

ACH Authorization Cancellation Request

Borrower Verification

ACH Cancellation Request

Borrower Acknowledgment and Compliance Disclosure

Reason for Cancellation (Optional)

Borrower Authorization

Servicer Use Only