To sign up, just complete, print and fax (or mail) it back to us at 303-666-1409. Make sure to include a void check or deposit slip.

I hereby authorize Finance America Corporation its assignees and/or successors hereinafter called Finance to withdraw the Payment Amount listed above from my checking or savings account as evidenced by the attached void check or deposit slip. The first withdrawal will be made on the Deduction Day following receipt of this Authorization. I agree that any payment returned unpaid will be subject to the same charges and treated in the same manner as a returned paper check. I also understand that these withdrawals will be made every month until the account is paid or until I give you written notice to terminate them. I understand that to ensure stoppage of a particular payment, my written notification must be received by Finance at least 3 business days prior to the withdrawal date.

Your Name:__________________________________________________________________________
Your Phone Number  With Area Code: (________)_________-_______________
Your Address:________________________________________________________________________
Your Account Number With Us:__________________________________________________________
What is the amount you wish us to deduct every month?:  $_________________________
(The deduction amount must be at least one full payment)
The payment should be deducted on, or shortly after, what day? (1 - 28):_______________
For more on the deduction day click here.
What city and state is your bank branch located? :____________________________________________
What is the phone number of your bank branch? (with area code): (_______)_________-_____________

Signed by, You must be a Signor on the Account: ____________________________________