CC Authorization Form – Nexus Funding 123

CC Authorization

Credit Card Authorization Form

Borrower(s) Name(s)(Required)

Property Address(Required)

Name as it appears on card

Credit Card Issuer(Required)

Visa

Mastercard

Amex

Discover

Credit Card Number(Required)

Expiration Date(Required)

MM/YY

CCV Code(Required)

(3 digit on back)

Billing Address(Required)

Billing Phone Number

Email Address

Check

Verification of Employment

Credit Report

Appraisal(s)

I am aware that these transactions are non-refundable. By signing below, you agree to the above mentioned items to be charged to the credit card on file through your loan with Nexus Funding 123.

Credit Report charges will show on your Credit Card Statement from Universal Credit Services.

Appraisal charges will show on your Credit Card Statement from Property Rate, LLC.

You will be provided with a copy of all Invoices.

Borrower's Signature(Required)

Type your name

Date(Required)

Team/Loan Officer

Loan Number

CAPTCHA

Name

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

CC Authorization

Riverside