Auto Payment Draft

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Cardholder Name                                                                                      Credit Card Account Number

I hereby authorize Card Assets to automatically withdraw (draft) my credit card payment from my (please select one):

r Checking Account                     r Savings Account          

which is at                                                                                            , as indicated below and to my credit card account for said payment.

(Name of financial institution)

I acknowledge that the origination of these ACH transactions to my account must comply with the provisions of U.S. Law.

Name of Bank or Financial Institution                                                                                     Branch Location, if applicable                     

Street Address                                                               City                                                State                              Zip Code      

Routing Number                                                                                                         Checking or Savings Account Number

I would like to have (Please choose one): *

r The minimum payment due drafted from my account each month. 

r The entire outstanding balance drafted from my account each month. 

I have attached a voided check or deposit slip for my account at the above-named financial institution.

If you have authorized us to pay your credit card bill automatically from your savings or checking account, you can stop payment at any time by notifying us by email at [email protected] or by phone at 800.854.7642 at least three business days before the automatic payment is scheduled to occur.  If you stop payment, you are still responsible to make your minimum payment by the due date.

Signature                                                                                                                         Date

*      Funds must be available in designated Checking/Savings account on the specified payment draft date. Card Assets will attempt to draft only once. If funds are not available on your credit card payment due date, your credit card account will become past due and you will receive a notice from Card Assets requesting payment. A $25 returned payment charge will be assessed to your account.   All other terms and conditions of your credit card account will remain the same.

Please return the completed form to CARD ASSETS: 

Fax: 770.805.2170

Scan and Email: [email protected]