Authorization Agreement for Automated Monthly Payments of Student Loans

Borrower's Full Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Last 4 of Borrower's SSN*

MMA ID#*

Loan Name(s)

Monthly Amount (Must be greater than or equal to monthly payment amount for each loan)*

Select one*

Includes loan in Grace, Postponement, or Deferment
Excludes loan in Grace, Postponement, or Deferment

I hereby authorize Maine Maritime Academy to initiate automatic withdrawals from my checking account in order for Maine Maritime Academy to credit the above referenced loan account for payment due. I agree that this will be initiated on the first day of every month; unless the first is on a weekend, then the transaction will occur on the last business day of the month for payment due the first of the next month. The withdrawal from my account will be deposited into the loan account of Maine Maritime Academy.

By typing and entering my name in the electronic signature box below I also authorize, if necessary, an additional fee of $15.00 for any and each time Maine Maritime Academy is unable to withdraw the sufficient amount. This applies to me as an "Admin Fee:. This is comparable to (possibly even less than) a charge for a insufficient funds check. This charge would be over and above any other late charges or interest accrual on the loan per the current existing loan agreement/promissory note.

This authority is to remain in full force and effect until MMA has received written notification from me to terminate this agreement in such time and in such manner as to afford MMA and its bank reasonable opportunity to act on it or until the loan is paid in full. MMA will initiate the final payment for the precise amount due at any point in time when that amount is less than the above monthly amount.

In order to activate this payment method I have typed and entered my name in the electronic signature box below accepting the terms of this agreement and understand that it will be submitted to the MMA Finance Department. I have also provided the numbers that are necessary to initiate this automatic payment (bank routing number and checking account number). Please attached a voided check, or type in the Routing and Checking Account numbers in the designated fields below.

Routing Number*

This number must be 9 digits long.

Checking Account Number*

Signature acknowledgement

By typing your name here, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this agreement.

Borrower's Electronic Signature*

First Last

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This form MUST be submitted by the 25th of the month prior to the month you want it to be effective. Any questions please call Diane Harmon at 207-326-2243or diane.harmon@mma.edu.

Name

This field is for validation purposes and should be left unchanged.