Credit Card Auto Pay Form 1 .pdf

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Original filename: Credit Card Auto Pay Form 1.pdf
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Author: Compass

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Authorization Agreement for Credit Card AUTOPAY
Credit Card Information (In order to qualify for Autopay Service drawn on a non-BBVA Compass
account, the customer must have made at least one prior payment by check.) Note: All fields are required.

Name on Credit Card Account*
Credit Card Acct Number
Plan Amount (select one):

Pay New Balance In Full

Pay Minimum Payment Due

Checking/Savings Account Information
Name on Checking/Savings Account*
Checking/Savings Account Number
Bank Routing Number

Usually the first nine numbers located at the bottom of
your check. If completed by customer please provide a
voided check with the completed form.

Email Address for Confirmation/Approval
*The name on the credit card account and the name on the checking or savings account must match.

Authorization
I request and authorize Compass Bank to make on going monthly electronic funds transfers via the
Automated Clearing House (ACH) network, in accordance with the National Automated Clearing House
Association (NACHA) Operating rules, for the Credit Card Autopay plan. I authorize debits from the account
I own, noted above, to make payment on my NBA American Express Credit Card account. The Plan amount
as noted above, will be debited from my account, on the payment due date as reflected on the account
statement, provided the designated payment account has sufficient funds. I also understand that any
payments I may make outside of the Credit Card Autopay plan, will only affect the scheduled Autopay plan
amount due, to the extent that it will not result in a credit balance. I understand that Credit Card Autopay
plan payments will appear on my monthly billing statements. I understand this authorization will remain in
effect until revoked in writing to Compass Bank Card Financial Services at P.O. Box 2210 Decatur, Alabama
35699. It may take up to one billing cycle to process my written revocation. I understand that I may request
a stop payment of any Credit Card Autopay plan scheduled payment to my NBA American Express Credit
Card by notifying Compass Bank Card Financial Services at 800 239-5175, not less than three (3) business
days before the next scheduled payment date. I understand that any requested change to the Credit Card
Autopay plan amount, indicated above, must be submitted in writing to Compass Bank Card Financial
Services, as noted above, and may take up to one billing cycle to take effect. Compass Bank Visa® Credit
Card terms and conditions apply.

Signature
Account Holder Signature
BBVA Compass is a trade name of Compass Bank, Member FDIC.

Date of
Authorization

Phone
Confidential 011/6/2015


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