Automatic Payment Authorization

Use This Form To Change Your Bank Information For Automatic Debits

Remember the commercials, “set it and forget it”? ACH authorized loan payments are a great way to ensure timely loan payments. Schedule your loan payment to be automatically deducted from your bank account. Report your new bank information to authorize us to electronically debit your bank account.

Questions? Our staff is here to help! Contact America’s Loan Company during normal office hours to answer your questions, or help you with the form.

ALL REQUESTS TO CHANGE A DEBIT HAVE TO BE RECEIVED BY 4:00 PM THREE (3) BUSINESS DAYS BEFORE THE DEBIT IS SUPPOSED TO HIT THE BANK ACCOUNT.

WE CAN NOT PROCESS CHANGES WHEN OUR OFFICES ARE CLOSED, DURING WEEKENDS OR HOLIDAYS.

Enter Your Contact Information

Enter your name as it appears on your loan contract

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Enter you best contact phone number

Enter you best contact e-mail address

Select the branch that processed your loan contract

Name Of Your Current Employer: (If Unemployed, or Pension or Social Security type that)

Financial Institution's Information

No. loss I

Financial Institution's Name

Account No.

Routing No.

Account Type

Checking
Savings
Prepaid Card
Other

By selecting YES, I authorize America's Loan Company to debit my bank account provided above on the date(s) and for the dollar amount(s) that have been discussed and agreed on. I understand that if I want to cancel or change this information, I may only do so by contacting America's Loan Company at dany@americasloancompany.com three (3) business days before the payment is scheduled to come out of my account.

Use This Section For Comments & Questions

By printing your name below, you authorize America’s Loan Company to submit electronic debits and credits to the bank account stated above. You also state that you own and are an authorized signer of the bank account stated above. This authorization will remain in effect until you give America’s Loan Company a written request to stop the electronic debits from my bank account. You indemnify America’s Loan Company and any of its service providers from any loss that you may incur due to the electronic debits to your bank account stated above. ALL NEW BANK INFORMATION MUST BE RECEIVED THREE(3) BUSINESS DAYS BEFORE THE DEBIT IS SUPPOSED TO HIT. Any requests submitted after 4:00 PM during our business day or on days that we are closed or on non-banking days, will be processed on our next business day. AFTER 4:00 PM during our business day or on days that we are closed or on non-banking days, will be processed on our next business day. We are closed Saturdays and Sundays, major holidays, and the weekday before or after a major holiday.

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