1000063 State Farm Bank, F.S.B. NMLS ID: 139716 134903.11 01-15-2018
REFERENCE #:
State Farm Bank
®
Automatic Payment Plan
The Automatic Payment Plan is designed to make bill
payment and record-keeping easier and more efficient. It is
an optional and convenient way to pay your loan payment.
Here are some of the advantages:
• Eliminates check writing and postage
• Reduces paperwork
• Saves time
• Minimizes the chance for a lost or late payment
• Payment made, even though you may be out of town
Here's how it works:
Your monthly payment becomes due each month but you
don't have to send us a check. The amount of your payment
is automatically withdrawn from your checking or savings
account on the due date and applied to your loan. You
simply write an entry to deduct the payment amount from
the balance in your bank account register.
Here are some common questions about the Automatic
Payment Plan:
Q: Is it safe?
A: Yes. State Farm Bank is authorized by you to withdraw
only the amount of the payment on the due date.
Q: Is there a charge for the Automatic Payment Plan?
A: There is no charge from State Farm Bank for this
service.
Q: What record will I have of an automatic payment from
my bank account?
A: The amount and date of the payment will show on your
bank statements.
Q: What if the bank statement shows a different date or
amount than my monthly payment?
A: Contact State Farm Bank as soon as you discover any
discrepancy. Your final payment may be different. You
will be notified to make the final payment manually if it
is greater than 110% of your normal payment amount.
Q: How do I stop an automatic payment or cancel my
participation in the plan?
A: Simply contact State Farm Bank in writing. The stop
payment or cancellation order must be received at
least ten (10) business days before your scheduled
monthly due date to be effective. Mailing address:
State Farm Bank: Attn: Loan Servicing, PO Box 5961,
Madison, WI 53705-5961. Fax#: (800)420-8124 Attn:
Loan Servicing.
Q: Am I required to choose a certain due date to have my
monthly payment deducted?
A: Your monthly payment will be deducted on the monthly
due date indicated in your Promissory Note.
Q: When does the money have to be in my bank account
for an automatic payment?
A: Your bank account must contain the full amount of your
payment, in available funds, on the due date of your
payment. If your payments are coming from a non-State
Farm Bank checking or savings account and there are
insufficient funds in your account on the payment date,
you may be charged a fee by your bank and also may
be charged a fee by State Farm Bank. Refer to your
Promissory Note for more information.
Q: What if I move or change bank accounts?
A: Contact State Farm Bank for a new Authorization form.
The ten (10) day cancellation time applies. Your bank
account must contain the full amount of your payment,
in available funds, on the due date of your payment. If
your payments are coming from a non-State Farm Bank
checking or savings account and there are insufficient
funds in your account on the payment date, you may be
charged a fee by your bank and also may be charged
the fee by State Farm Bank. Refer to your Promissory
Note for more information.
Q: How do I sign up for the Automatic Payment Plan?
A: Complete, sign, and return the Authorization form
below. We will send you a letter to let you know that we
received your enrollment request. The letter will explain
when the automatic payments will begin. Mail the
completed Authorization form to:
State Farm Bank
Attn: Loan Servicing
PO Box 5961
Madison, Wisconsin 53705-0961
CREDIT REPORTING: Lender may report information
about your account to credit bureaus, including negative
information. Late payments, missed payments, or other
defaults on your account may be reflected in your credit
report. Borrower authorizes Lender to obtain consumer
reports about Borrower until the Note is paid in full.
DISPUTING ACCOUNT INFORMATION REPORTED TO
CREDIT BUREAUS: We furnish information about your
account to credit bureaus. You have the right to dispute the
accuracy of the information reported by writing to us at:
State Farm Bank, F.S.B., ATTN: Credit Reporting, P.O. Box
2313, Bloomington, IL 61702-2313.
1000063 State Farm Bank, F.S.B. NMLS ID: 139716 134903.11 01-15-2018
Automatic Monthly Payment Plan Authorization
CUSTOMER INFORMATION
Name & Address
Loan No.
Daytime Phone Number
BANK INFORMATION
Bank Name
Bank Routing No. Bank Account No.
Personal Checking* Personal Savings*
Business Checking* Business Savings*
*Optional: Please attach a voided check or savings deposit slip to ensure prompt
and accurate processing.
AUTHORIZATION
I (we) authorize State Farm Bank or its service provider to initiate a deduction from my (our) State Farm Bank deposit
account or an Automated Clearing House (ACH) entry to my (our) bank account at the bank identified on this form on my
(our) monthly due date for the regularly scheduled payment as disclosed on the Promissory Note and Security
Agreement. I (we) understand that I (we) remain responsible for other accrued interest or fees due on my (our) loan which
will be billed separately. If the payment date is on a non-banking day during a particular month, the payment may pull on
the business day before or after your due date, depending on your financial institution. I (we) understand that my (our)
final payment may be different. I (we) will be notified to make the final payment manually, if it is greater than 110% of my
(our) normal payment amount.
This authorization is to remain in effect until State Farm Bank receives written notification from the customer or the
checking/savings account holder of termination from the plan. It is understood that State Farm Bank must receive this
written notification at least ten (10) business days before a payment due date. Written notification of stop payment or
cancellation can be mailed or faxed to the Bank. Mailing address: State Farm Bank: Attn: Loan Servicing, PO Box 5961,
Madison, WI 53705-5961. Fax#: (800)420-8124 Attn: Loan Servicing.
NOTE: Please be advised that any automatic payment item from a non-State Farm Bank checking or savings account that
is returned unpaid will be subject to a fee as disclosed in your Promissory Note and may result in cancellation of
automatic payment privileges.
Name(s) of Check/Savings
Account Holder(s)
Signature(s) of Checking/Savings Account Holder(s)
X
Date
X
Date
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