Mortgage Automatic Payment Form

Telhio Credit Union is herby authorized to debit my (our) share draft/checking or share/savings account at the credit union listed below through MAP (Monthly Automatic Payment). My (our) credit union account will be debited only for a current mortgage payment amount and funds will be applied to my (our) Telhio mortgage loan number listed below.

I (We) request that this authorization will commence on the date listed below. This authorization will remain in effect until terminated by written notice from Telhio Credit Union, Inc. or me (us), received by the other at least ten (10) days prior to the next scheduled payment due date. It is Telhio Credit Union's intention to draft my (our) account on the first or second business day of each the month. I (We) understand that a non-sufficient funds (NSF) fee may be charged, as allowed by the applicable law, if any item is returned for any reason. If a debit is returned for any reason, I (we) must properly remit payment by share draft/check/money order.

Please print and fax this form to Telhio Mortgage Department - 614-225-2405


Mortgage Loan Number                      MAP Payment Start Date: (Month/Day/Year)

Name(s) on Account
(if the account is jointly held, both account holders names must be listed  and signed below)

 

Joint Account Holder's Name (if applicable)

 

Street Address                     City                             State                 Zip

 

Credit Union                                                         City                        State
 Telhio Credit Union                                           Columbus               OH
Your Credit Union Account Number        Check One:   _______  Share Draft/Checking 
                                                                               _______  Shares/Savings
Your Credit Union Routing Number
   244077323

Regular Monthly (Principal + Interest + Escrow)

 

 $       
Plus additional to principal +   
Plus additional to escrow +
Total amount to be debited $
Print Account Holder's Name

Signature                                       

 

Print Joint Account Holder's
(if applicable)

 

 Signature