Enrollment Form for Automatic Payments

Enrollment Form for Automatic Payments

I hereby authorize Payee to initiate a debit entry from My Bank to deduct the Withdrawal Amount automatically from My Account, without giving me any further notice.

1. My Mortgage means the loan which is serviced by the Payee, secured by my property and identified with loan number

2. Address of the Property Covered by this Mortgage:

3. Account means the account identified below at My Bank. Please make automatic withdrawals from my:

Checking Account Savings Account

Account Number:

Bank Routing Number (ABA Number):

My Bank means the depository financial institution where My Account is held:

My Bank:

4. My Withdrawal Date means: For loans whose payments are made Monthly, begin on (DATE) and on the same day of every month thereafter.

$ (Mortgage Payment)

+ $ (additional principal)

= $ (Withdrawal Amount)

By signing below I acknowledge that I agree to the terms on both sides of this Enrollment Form, and that I have received this Form and kept a copy for my records.

My Bank:

Please read both sides of this form carefully. Then complete and mail it by August 26, 2013 using the enclosed envelope to: M&T Bank, Attn: ACH Department, DE MB-38 Retail Servicing, P.O. Box 900, Millsboro, DE 19966-4508.

Keep this information handy for reference. Use this form to ensure continued automatic drafting of your payments. It’s the easiest way to make sure your mortgage payments are always made on time.

PAYMENT OPTIONS CARD

• Online Payments: mtb.com/mymortgageinfo

• Payments by Mail: P.O. Box 62182, Baltimore, MD 21264-2182

• Automatic Deductions: Enroll now or later at mtb.com/mymortgageinfo

• Bill-paying services: When using bill-paying services offered by other banks and financial institutions, be sure to update the payee name to “M&T Bank.”

• Pay-by-Phone: 1-866-241-6014 (A nominal fee may be assessed for this service)

• Pay at M&T branch or through Western Union: Call 1-866-241-6014 for the nearest Western Union location

Authorization Agreement for Automated Clearing House (ACH) Debits (Automatic Payments)

1. “I”, “me”, “my” or “mine” mean or refer to each and every person signing this Authorization. “Payee” means M&T Bank, its agents, successors and/or assigns. “My Mortgage Note” means the note that I signed when my mortgage closed and any amendments or modifications thereto.

2. I authorize my Bank to debit Withdrawal Amounts as shown on the front of this form from my Account upon receipt of each debit entry from Payee and to transfer such amounts to the account of Payee held at Manufacturers and Traders Trust Company (“M&T Bank”). I understand that my Bank must be a member of the National Automated Clearing House Association (NACHA).

3. I understand that banks and ACH operators such as NACHA are entitled to rely on Account and Routing Numbers as given by me and that I will be liable for any losses incurred by any person if I have given a wrong account number for my Account or the wrong Routing Number (encoded on the front of my check) for my Bank, and if as a result the wrong person’s account is debited for my Mortgage Payment. I HAVE CHECKED MY ACCOUNT NUMBER AND MY BANK’S ROUTING NUMBER WITH EXTRAORDINARY CARE. I am responsible for their accuracy.

4. If the balance available for Withdrawal from my Account is not enough to cover the Withdrawal Amount on any Withdrawal Date, or if my Bank returns, rejects or reverses the debit entry to my Account for any reason, I will still owe that Mortgage Payment; and the Payee and/or owner of my Mortgage Note may, at its option, treat this as a failure to make a Mortgage Payment. The Payee and/or owner of my Mortgage Note may then take any of the actions that my Mortgage and my Mortgage Note permit it to take in the event I fail to make a payment. Additionally, Payee may charge a returned item fee to my Mortgage account. I understand that the amount of the fee will not exceed the maximum amount permitted by law.

5. I understand that if my withdrawal Date falls on a weekend or legal or banking holiday, Payee will initiate the applicable transaction on the next business day. This will not change the date of any subsequent Withdrawal Date.

6. I understand that if I am in default under the terms of my Mortgage, Payee may cease debiting payments from my Account until such time as I am again current under the terms of my Mortgage.

7. I HEREBY CERTIFY THAT NO AUTHORIZATION OF ANY PARTY OTHER THAN MINE IS NECESSARY TO PROVIDE FOR THE WITHDRAWAL OF FUNDS FROM MY ACCOUNT THAT ARE CONTEMPLATED BY THIS AUTHORIZATION.

8. I understand that if there is a change in my Mortgage Payment (either up or down), the Withdrawal Amount will change accordingly. Payee is authorized to debit my Account for the new Withdrawal Amount (the new Mortgage Payment plus any additional principal or other amounts specified on the front of this form) and Payee will notify me of any such change prior to the first Withdrawal Date at the new amount. If I receive notice about a change in the amount of my Mortgage Payment, I will consider that as notice of a change in my Withdrawal Amount, and Payee is authorized and directed to initiate debit entries from my Account for the adjusted Withdrawal Amount, which will be equal to the new Mortgage Payment amount plus any additional principal or other amount specified on the front of this form.

9. This Authorization will remain in full force and effect until: (a) Payee terminates this Authorization at any time and for any reason after giving me reasonable notice; or (b) Payee has received written notification from me of its termination in such time and in such manner as to afford Payee a reasonable opportunity to act on it prior to charging my Account.

10. If Payee for any reason changes the Withdrawal Date, Payee will send me written notice of the new Withdrawal Date.

11. I understand that Payee has the right to enforce my Mortgage and my Mortgage Note under their stated terms and this Authorization in no way modifies my Mortgage Note, my Mortgage or any other documents I signed in connection with my Mortgage loan.

12. I understand that I may not assign this Authorization to another party. I understand that I may change my Account designated on the front of this form by giving Payee written notice at least 15 business days prior to the next Withdrawal Date.

13. I understand that this Authorization will not be effective until it has been received by Payee and Payee has had a reasonable opportunity to act upon it. In the meantime I will continue to make my monthly mortgage payments when they are due.