Notice Of Assignment Or Transfer Of Your Mortgage Loan - Ctbc Bank Page 3
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3PAYMENT AUTHORIZATION FORM
Use this form to create automatic payments for your CTBC Bank Corp. (USA) loans.
IMPORTANT INFORMATION
Mail, Fax or Email this completed page and a voided check (NO DEPOSIT SLIP) to:
CTBC Bank Corp. (USA)
Loan Servicing Department
P.O Box 80038
City of Industry, CA 91716-8038
Fax: (626) 965-3516
Email:
Loan Number: _______________________________________________________________________________
BANK ACCOUNT FUNDING
Please print bank information in CAPITAL LETTERS (Information is available from your bank). Submission of
this payment authorization is acknowledgment that I am an authorized signer on the bank account listed for
the direct payments.
Bank Name: ________________________________________________________________________________
Bank Checking Account Number: ______________________________________________________________
Bank ABA Number (Routing Number, located on the bottom of your check): __________________________
AUTO DEBIT AUTHORIZATION
I authorize CTBC Bank Corp. (USA) to automatically debit my bank account monthly for the amount of my
full loan payment. I understand that the payment amount may vary due to changes in escrow requirements
or principal and interest payments for adjustable type mortgages, if applicable. CTBC Bank Corp. (USA)
is authorized to debit my bank account until CTBC Bank Corp. (USA) has received written notification to
terminate this service. Termination request must be received by CTBC Bank Corp. (USA) fifteen (15) days
prior to the next scheduled monthly draft. I acknowledge that CTBC Bank Corp. (USA) as the originator of
the ACH debit transactions to my account must comply with the provisions of U.S. law.
Please CONTINUE MAKING PAYMENTS until we notify you by mail when automatic payments will
begin. This may take up to 30 days. Your account must be current and any late charges must be paid
before automatic payments will be authorized to begin.
Select a date between the 1st – 15th that you want the loan payment to be withdrawn: _________________
Print Borrower’s Legal Name: __________________________________________________________________
Borrower’s Daytime Phone Number: ____________________________________________ Ext: ___________
Borrower’s Signature: ________________________________________________________________________
Date: ______________________________________________
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