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tel:
888.868.8467
Home
Loan Programs
Fix and Flip Loan
Bridge Loan
30 Year Rental Loan
Borrower Tools
Borrower Portal
Submit Loan Application
Preferred Borrower Account
Request Construction Draw
Request Proof of Funds
Brokers
Loan Programs
Broker Portal
Preferred Broker Account
Submit Loan Request
Investing
TaliMar Income Fund
Available Trust Deeds
Investor Portal
Start Investing Today
New Investor Account Form
Video Blog
Request Executive Summary
About
About TaliMar Financial
Meet the Team
Blog Posts
Recently Funded Loans
Before & After Photos
Contact Us
Upcoming Events
Contact Us
888.868.8467
toll-free
ACH Payment Authorization Form
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Borrower Name
*
Phone number for Borrower
*
Address of primary property securing the loan
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mailing address for Borrower
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Name of Bank
*
Account Type
*
Personal Checking
Business Checking
Personal Savings
Business Savings
Account Number
*
Routing Number
*
Day of month for automatic withdrawal
*
Select One
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
Withdrawals will be made on this day each month, or the next business day.
Payment amount
*
Authorization
*
I/We hereby authorize a monthly ACH electronic debit from the account designated above to be paid to FCI Lender Services, Inc., in payment of my/our monthly loan obligation, not to exceed the amount agreed to by me/us below. Provided however, if the required scheduled loan payment changes for any account related reason, including but not limited to change in principal balance, interest rate, or in required escrow/impounds, I/We authorize the debit amount to be adjusted accordingly. I/We understand that should my/our bank dishonor my/our automated payment for insufficient or uncollected funds, the original amount, plus an additional NSF fee, as allowed by law, may be electronically debited from my/our account. I/We authorize FCI to debit my/our account consistent with this Authorization until such time as I/we provide 15 days written notice to FCI of withdrawal of this Authorization. NOTE: The electronic debit date can not be changed with less than 15 days written notice prior to the next scheduled debit date sent to FCI Lender Services, Inc. at the address or fax numbers above
Signature
*
Clear Signature
Submit
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