Virginia Housing
Authorization for Multifamily Disbursements
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
Credit Authorization
Virginia Housing may initiate credits to the account for remittance of monthly Housing Assistance Payments, reserve
disbursements, escrow payments, 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
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