§         By signing this form, you authorize Novadebt to withdraw your monthly plan amount directly from your checking or savings account each month

§         Proof of payment will be reflected on your monthly Novadebt statement

§         The authority you provide to deduct your payment will remain in effect until you speak with a Novadebt representative to terminate the authorization

§         If the amount of your debit changes, Novadebt will notify you, in writing, at least 10 days before your next debit. If we do not hear from you regarding this change in debit, the new amount will be withdrawn for your next scheduled debit.

§         If you need to cancel or change the date of your debit, Novadebt requires 3 business days notice. If we do not receive 3 business days notice, we cannot guarantee the ability to comply with your request.

§         Please be advised that changing your debit date may have a negative impact on your status with your creditors and could lead to a loss of creditor benefits. (i.e. your minimum payment and interest may increase and you may start to incur late and/or over-limit fees).

 

Please complete the information below and return it to Novadebt:

 

I authorize Novadebt to initiate electronic debit entries to my checking / savings account for my monthly Debt Management Program payment. By signing below, I am authorizing a debit in the amount of $____________________, which is my current monthly plan amount. If the amount is to be higher than my plan amount listed on this form, I understand that Novadebt will provide me with written notice 10 days prior to the debit date, which would include the increased payment. I also understand that if I do not approve the increase to be debited, I must contact Novadebt at least 3 business days prior to my next scheduled debit date to notify Novadebt that the increased amount should not be withdrawn.

 

I agree to have my account debited a minimum of $______________ on the _________ of each month, beginning on ________________.

 

I/we authorize Novadebt to initiate entries to my account listed above and, if necessary, to initiate adjustments for any transactions credited in error.  If a debit is returned unpaid due to “Uncollected”, “Insufficient Funds”, “Refer to Maker”, “Stop Payment”, “Closed Account”, etc., Novadebt will not process it again, therefore a payment must be submitted via another approved method.  A $10.00 (ten) fee will be assessed for returned drafts.

 

I acknowledge that the origination of ACH transactions to my account must comply with the provisions of United States law. This authorization will remain in effect until Novadebt receives verbal or written notification at least 3 business days prior to the next scheduled debit date.

 

I/we agree with all of the provisions of this authorization and hold Novadebt, its directors, employees, officers and its agents harmless from any damages that may occur arising out of my/our authorization.

 

Date:                _____________________                                                      Client Signature: ______________________

 

Client Name:    _____________________                                                     Account Type (Check One): ¨ Checking    ¨ Savings

 

Bank Name:     ______________________                                                    Bank State: __________________________

 

Bank Routing #:               ______________________                                    Bank Account #: ______________________

---

225 Willowbrook Road Freehold, New Jersey 07728

Member AICCCA Online Form

800-77-BILLS Fax 732-863-5051 www.novadebt.org