Virginia Housing
Authorization for Multifamily Automatic Payment Transfers
Form must be completed in full
Property Information
Development Name:
Virginia Housing Loan Number:
Mortgagor or Management Agent:
Contacts
Primary Contact:
Phone (ext.):
Email Address:
Secondary Contact:
Phone (ext.):
Email Address:
Bank Account Information
Account Name:
Bank Name/City:
ABA Number:
Account Number:
Account Type: Checking
Select Payment Date
Select the day of the month on and/or after which mortgage payments are authorized to be debited each month. If such a day
is not a banking day, the mortgage payment will be debited on the first banking day following the day so selected.
NOTE: Payments must be received prior to the late charge application date.
☐ 1
st
☐ 5
th
☐ 7
th
☐ 12
th
☐ 25
th
(advance payments only)
In addition to authorization for automatic debits, Virginia Housing may initiate credits to the account for transactions such
as reserve disbursements, escrow refunds, etc.
Agreement Terms
Beginning on _______ (month, day, year), the undersigned hereby authorizes Virginia Housing to initiate debit and/or
credit entries to the undersigned’s account at the financial institution indicated above. The undersigned further authorizes
the financial institution to debit and/or credit the undersigned’s account. This authority shall remain in effect until revoked
in writing by the customer or Virginia Housing, or until such time as the mortgage terminates. Virginia Housing shall be
given 30 days to act upon termination. Virginia Housing has the right to have the amount of an erroneous debit or credit
corrected up to 5 days following the transaction.
Authorized Signature(s)
________________________________________________
________________________________________________
Mortgagor/Management Agent
Date:
Return completed form to the address below:
Virginia Housing Rental Servicing
601 South Belvidere Street, Richmond VA 23220-6500
(804) 343-5860 / (804) 782-1986 / (804) 783-6705 TDD
click to sign
signature
click to edit
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