Carefree Payment Program

Automatic Payment Details

I/We authorize First Federal Savings Bank to electronically debit my/our account and if necessary, electronically credit my/our account to correct erroneous debits as follows.

Recurring entries (that recur at substantially regular intervals without my affirmative action to initiate future entries). Loan Account Number Beginning Date Payment Amount Monthly

*The regular payment option will pull what has been billed, ie - Int. Only Pmts, Principal & Interest, etc. It will also adjust the auto draft due to changes in the interest rate or payment amount.

Please draft or withdraw this additional amount each month and apply to principal.

*Please note that if your regular monthly payment amount changes, due to escrow adjustments or interest rate changes, this additional principal amount will not update automatically and can only be changed with a newly signed authorization.

Please complete the below fields with your Depository Insitution's details

Bank Name Bank Routing Number Select Account Type Checking Savings Account Type Account Number

Authorization - Signature

I/We understand that this authorization will remain in full force and effect until First Federal Savings Bank is notified in writing, by email or by phone that this ACH authorization is revoked, or I am notified by First Federal Savings Bank that they are terminating my automatic payments. I/We understand that First Federal Savings Bank may restrict or terminate automatic payments if three or more payments have been returned or if First Federal Savings Bank has been notified that the account being drafted from is closed, among other reasons. I/We understand that First Federal Savings Bank requires at least three (3) days prior notice in order to cancel this authorization.

Signature Date