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Bi-Weekly Application

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MORTGAGE SAVINGS PROGRAM^TM
^{Enrollment Form and Automatic Debit Authorization}

AAA Financial Corp., herein referred to as AAA, and the individual(s) named below, hereinafter referred to as Client, hereby agree to the following:

1. ENROLLMENT/PURPOSE. Client agrees to enroll in AAA's Mortgage Savings Program^TM payment plan for the purpose of accelerating the amortization of Client's loan.
			Mr.	Mrs.
Client Borrower's Last Name (Please Print)	First Name	Mid. Init.	Ms.	Dr.	Date of Birth
			Mr.	Mrs.
Client Borrower's Last Name (Please Print)	First Name	Mid. Init.	Ms.	Dr.	Date of Birth	Social Security No.


Client Borrower's Property Address	City	State	Zip	Day Phone No.

Client Borrower's Mailing Address (if different from property address)	City	State	Zip	Evening Phone No.

2. CLIENT MORTGAGE INFORMATION (Please Print)

Name of Lender Loan Number

Lender's Address City
State Zip

Lender's Phone No. Orig. Loan Amt. $ Term (Months) Interest Rate %

Date of Orig. Loan Mth. Pmt. (P&I) $ Escrow, if any (taxes & Ins.) $ Ttl. Mth Pmt. $

Due Date: the th. Grace Pd. days. Loan Type: Fixed Variable Other Last pymt. sent

3. CLIENT BANK DEPOSITORY INFORMATION

AUTHORIZATION FOR AUTOMATIC BI-WEEKLY DEBIT TO BANK ACCOUNT AND MONTHLY MORTGAGE PAYMENT

To: Debit Bank
Address City State Zip
Electronic Transfers. My bank account number is . I (we) authorize AAA or assigns, to initiate debit entries to the above account identified by the attached voided check or savings account deposit slip.
Type: Checking Savings
NOTE: Credit Unions may not be draftable! Call Credit Union to verify!
I (we) agree that, unitl I (we) give the bank written notice canceling this Authorization, the bank should pay electronic fund debits or other debits ordered on the account. I (we) authorize AAA, or assigns, to charge the account for the following purposes only:

$	to be debited every two weeks, which is 1/2 of monthly mortgage amount. This amount will be forwarded to my mortgage company. This figure also includes any principal payments.
$	to be debited twice monthly, on the fifth and the twentieth days of the month. (If debit transfer falls on a weekend, transfer shall occur on the preceding Friday.) This amount includes 1/2 of monthly mortgage amount plus 1/24th of current monthly payment.
$2.95	to be debited every two weeks, or on the fifth and the twentieth days of the month (Depending on the option chosen above), which is a service fee to cover processing.
$	to be debited every two weeks, which is 1/2 of the Mortgage Savings Plus Premium plus a $1.00 service fee. This amount less the service fee per debit will be forwarded to the designated life insurance company(s) monthly. Client acknowledges receipt of Life Insurance proposal illustrating guaranteed and projected values. Client's Initials
$	to be debited every two weeks for a period of twelve (12) debits. This includes a $5.95 service fee per debit for twelve (12) debits. This plus the initial enrollment down payment of $ will be our total enrollment fee. Upon our cancellation of the Mortgage Savings Program^TM, any unpaid balance of the Enrollment Fee may be offset against the Account.
$	Total Amount authorized to be debited from my account every two weeks.

Your Mortgage Savings Start Date will be . First debit date MUST be four (4) Fridays before actual mortgage due date. Allow three weeks from submission date for processing and verification. You will be notified in writing concerning start date. Please continue to make monthly payment until notified. (Client initials.) I (we) also authorize a late fee of $20 each time a debit fails because of insufficient funds. The exact name(s) on the Account is/are: (please print)

(Check only if applicable.) I (we) would prefer to be billed directly once a month for our current mortgage amount plus 1/12th that amount instead of the Bi-weekly Bank Debit. We understand that the Billing Service fee is $7.50 per month. (Client initials)

4. LEGAL RIGHT TO CANCEL. You as Client have a legal right to cancel this transaction, without cost, within three business from the date you receive this notice of your right to cancel. This date is stated below and acknowledged by filling out the fields below. Client agrees any refund due will be between Client and Consultant only. AAA will not be held responsible for any refund concerning enrollment fee.

5. ACKNOWLEDGEMENT. By filling out the fields below, Client acknowledges paragraphs 1 through 15 have been read, understood and agreed to.
Name: E-mail Address:
(Don't have an e-mail address? Get one free!)
Date:

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