Payment Authorization Form Embedded - BridgeCo Financial

BridgeCo Financial

COMMERCIAL REAL ESTATE LENDER

Bridgeco Financial - Payment Authorization Form

Payment Authorization Form

BridgeCo Financial, LLC (“BridgeCo Financial”) is committed to keeping private, secure, and confidential any and all personal and business information we collect from you when you visit our website and submit information through any of our forms. Our Private Policy is that we will use your information strictly for our business use in evaluating your Loan Application and in servicing any loan we provide to you. Your information will not be disclosed to, sold to, or otherwise used for the benefit of any third party.
Full Name *

First Name Last Name
Property Address *

Street Address

Street Address Line 2

City State

Zip Code
E-mail *
example@example.com
Phone Number *
Please enter a valid phone number.

NOTE: Please select the Authorization Type for your account. By default, the form is selected to be used for BOTH the Interest Payment and the disbursement of your Rehab Draw.
Authorization Type

Interest Payment Rehab Draw
Account Type *

Business Checking Business Savings Personal Checking Personal Savings
Account Owner Business Name
Business Name or Legal Name
Account Owner Individual Name
Secondary Name (if applicable)
Account Owner Mailing Address *

Street Address

Street Address Line 2

City State

Zip Code
Account Number *
8-11 NUMBERS (NO SPACES)
Routing Number Wires *
BANKS MAY HAVE SPECIFIC WIRE NUMBERS THAT DIFFER FROM THE ACH. PLEASE VERIFY WITH YOUR BANK FOR THE APPROPRIATE NUMBER.
Routing Number ACH *
9 NUMBERS (NO SPACES) - COMMONLY FOUND ON THE BOTTOM LEFT CORNER OF CHECKS.
Bank Name *
Bank Address
Address, City, State
Bank Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Bank Phone Number *

Please verify that you are human. *
Form

Interest Payment & Rehab Draw Authorization Form
Date *

Month Day Year
Opt-In for Electronic Correspondence

I hereby request that you make my account statements available for all the accounts with BridgeCo Financial and affiliated entities via online banking rather than postal mail each time such document would be sent to me via postal mail. Please continue to do so until I withdraw this request as described above I DECLINE Electronic Correspondence
Acknowledgment, Permission, and Signature

I authorize BridgeCo Financial, LLC ("BridgeCo Financial") to electronically initiate interest payments and/or deposits for approved reimbursement requests on behalf of the account indicated in this Interest Payment & Rehab Draw Authorization Form in accordance to the terms outlined above. I understand that this authorization will remain in full force and effect unless and until I notify BridgeCo Financial in writing with at least one-week prior notice to revoke this authorization. I certify that I am an authorized signor on this Account and will be responsible for all costs, expenses or other fees and charges incurred by BridgeCo Financial as a result of any failed or returned transfers, whether resulting from Non-Sufficient Funds (NSF) being available in the Payment Account, or otherwise. I understand that BridgeCo Financial may attempt to again process the transaction in its discretion anytime within 30 days.
Signature *

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