Co-borrower's Authorization

Credit/Debit Card Automatic Payment Withdrawal Authorization Form for Co-borrowers

A. Borrower’s Information – 
Full Name:

Co-Borrower’s Information: 

B. Billing Information (Credit/Debit Cards) – Please complete this section if you have chosen to have your payments automatically processed via Credit/Debit cards each period
Name as it appears on card:    
Billing Address:  City :  State:  Zip:   
Card Options:  MasterCard, Visa, Discover and American Express

Credit/Debit Card Number (no spaces): 
Card Expiration Date:  Card Verfication Code: 

C. Automatic Withdrawal Frequency & Amount

Authorized withdrawal amount:   
Starting Date(s) 

Sign Date:

I Authorize Kings Enterprises INC to automatically process payments and late fees from my above listed Credit /Debit Card on the frequency and dates selected in section C. I understand that I am authorizing this card to be put on file on a loan account in the name of NAME. I also understand that this card will be billed for the due payments for this account.

Mailing Address:
Kings Enterprises INC
505 North Garden St
Columbia, TN 38401

Credit/Debit Card Automatic Payment
Withdrawal Authorization Form
Account: OL-

Leave this empty:

Kings Firearms and More
Signature Certificate
Document name: Co-borrower's Authorization
Unique Document ID: 22c41206634f5fe81d537474de9018bc34518785
Timestamp Audit
November 6, 2017 10:38 am CDTCo-borrower's Authorization Uploaded by John King - IP