Automatic Mortgage Payment Enrollment Form
Match your mortgage payments to your payday cycle
Managing your mortgage payments is easy when you enroll in automatic payments. Simply choose the option
on the next page that matches your personal payday cycle, and your monthly payments will be withdrawn
automatically from your checking or savings* account. Automatic mortgage payments are secure and more
convenient than writing checks and mailing payments. This plan is not required; it’s one of many options you
may choose from to make your mortgage payments.
Please note: Enrolling in automatic mortgage payments does not change the principal and interest payment
arrangement specied in your mortgage loan documents. Withdrawn funds may be applied to your mortgage
when sucient funds have accumulated to make a full monthly payment as outlined in your mortgage note.
Automatic mortgage payment terms and conditions
You must agree to the terms and conditions below by completing and signing the form located on the following page:
• I understand that only a borrower on the loan can enroll in automatic mortgage payments. I am not a third party.
• I authorize Wells Fargo, its authorized representatives, and service providers to initiate electronic withdrawals from my
designated account to make payments on my mortgage.
• I understand that I, or another borrower on the loan, must be the owner on the deposit account used for electronic withdrawals.
• I understand that a business account can only be used to set up electronic withdrawals for my mortgage loan if the
business is on the Mortgage Note as a borrower.
• I understand that I will receive conrmation specifying the date the electronic withdrawals will begin. I understand that I
will continue to make my payment until I receive this conrmation and electronic withdrawals begin.
• I understand that this authorization and the program services in no way alter or lessen my obligation under my
existing mortgage contract regarding the amount of payments, when payments are due, the applications of
payments, the assessment of late charges, or the determination of delinquencies. I must maintain sufficient
funds in my account for withdrawal of my payment amount.
• I understand that withdrawn funds may not be applied to my mortgage until sucient funds have accumulated for a full
payment to be made.
• I understand that the electronic withdrawal amount will vary with changes in escrow or principal and interest components, if applicable.
• I agree to be bound by the program’s Terms and Conditions, which are stated here and online.
Automatic mortgage payment enrollment and change options
Note: We must receive notication at least three business days prior to any requests to temporarily stop, change or cancel
participation in automatic mortgage payments.
Can I do this by fax or mail? Can I do this online? Can I do this by phone?
Enrolling in automatic
payments
Yes. Yes, if you access your
mortgage online.
Yes.
Temporarily stopping
payments, canceling, or
making other changes
once I’m enrolled
Yes. You can cancel payments
online. To temporarily stop
payments or make other
changes, call us.
Yes.
How can I do this?
Fill out and sign this form.
Fax to: 1-866-287-6241
Or mail to:
Wells Fargo Home Mortgage
PO Box 10335
Des Moines, Iowa 50306
Sign on to your mortgage
account using the Wells
Fargo Mobile® app or at
wellsfargo.com.
Call us at 1-866-386-8519.
Note: There are two copies of the form, one for you to ll out and send to us, and one for you to keep with your records.
Page 1 of 2
Fill out this form and return to us using the instructions on page one,and keep a copy of this form with your records.
1. Select the automatic mortgage payment option that matches your pay schedule
Check the appropriate box to mark your choice. If this form is signed, but no option is checked, you will be set up for
monthly withdrawals on your due date.
If you choose the weekly or every-other-week option, withdrawals in addition to the amount needed to cover
your monthly mortgage payments will naturally occur 2 to 5 times per year. The additional withdrawn funds will
be automatically applied to your principal balance – helping you pay off your mortgage faster. For all options
below, the monthly payment includes principal, interest, tax, insurance, and escrow payments, if applicable.
Weekly: One-quarter of your monthly payment amount will be withdrawn every week. In a year’s time, 52 withdrawals
will be made.
Request a withdrawal start date (must be Mon. – Fri. and 4 weeks prior to due date): / /
Every other week (bi-weekly): Half of your monthly payment amount will be withdrawn every other
week. In a year’s time, 26 withdrawals will be made.
Request a withdrawal start date (must be Mon. – Fri. and 3 weeks prior to due date):
/ /
Twice a month (semi-monthly): Each withdrawal will equal one-half of the total monthly payment due. The full payment
must be withdrawn before the end of your grace period. Fill in the dates you would like for each half of your payment to be
withdrawn. Half of your monthly payment will be withdrawn on the of the month and
the second half will be withdrawn on the . In a year’s time, 24 withdrawals will be made.
Monthly: Your monthly payment amount will be withdrawn on your due date, or you can delay your monthly payment
up to 14 days after your due date. Mark below to select the number of days you would like to delay your payment.
Due date 1 day after 2 days after 3 days after Other (up to 14 days)
2. Specify additional principal to be withdrawn (optional)
Do you want to add an additional amount to each automatic payment? It will go directly to your outstanding loan principal,
if the loan is current. This will help you pay o your mortgage faster. If you want to do this, check the box below and let us
know how much you want to add.
Yes, please add $ to each of my automatic electronic withdrawals.
3. Supply your account information — You must be an owner on the deposit account
You can withdraw from up to 4 dierent accounts.
Account Type
(Checking or
Savings*)
Bank routing number
(9-digit number at
the bottom left of
your check)
Bank account number
(To the right of the
bank routing number
on your check)
Name on
bank account
Amount or % to be
withdrawn from
each account
(If you’re using more
than one account)
4. Signature
By signing below, I agree to the terms and conditions on the preceding page and online at wellsfargo.com/automaticpayterms. I also
certify that I own the account(s) above and that I’m a borrower on the loan number below.
Customer(s) name (print): Customer phone number:
Property address:
Customer loan number:
Customer signature:
Date signed:
Customer signature:
Date signed:
Note: This form must be received and processed within 120 days of the date it’s signed. Otherwise, we’ll need you to complete a new one.
* Other nancial institutions may assess excess activity fees on savings accounts. For more information, please refer to your account agreement with that nancial institution.
Wells Fargo Home Mortgage is a division of Wells Fargo Bank, N.A. 595909 (Rev 08/21) SVGv16 Page 2 of 2
© 2021 Wells Fargo Bank, N.A. All rights reserved. NMLSR ID 399801.
Automatic Mortgage Payment Enrollment Form
Match your mortgage payments to your payday cycle
Managing your mortgage payments is easy when you enroll in automatic payments. Simply choose the option
on the next page that matches your personal payday cycle, and your monthly payments will be withdrawn
automatically from your checking or savings* account. Automatic mortgage payments are secure and more
convenient than writing checks and mailing payments. This plan is not required; it’s one of many options you
may choose from to make your mortgage payments.
Please note: Enrolling in automatic mortgage payments does not change the principal and interest payment
arrangement specied in your mortgage loan documents. Withdrawn funds may be applied to your mortgage
when sucient funds have accumulated to make a full monthly payment as outlined in your mortgage note.
Automatic mortgage payment terms and conditions
You must agree to the terms and conditions below by completing and signing the form located on the following page:
• I understand that only a borrower on the loan can enroll in automatic mortgage payments. I am not a third party.
• I authorize Wells Fargo, its authorized representatives, and service providers to initiate electronic withdrawals from my
designated account to make payments on my mortgage.
• I understand that I, or another borrower on the loan, must be the owner on the deposit account used for electronic withdrawals.
• I understand that a business account can only be used to set up electronic withdrawals for my mortgage loan if the
business is on the Mortgage Note as a borrower.
• I understand that I will receive conrmation specifying the date the electronic withdrawals will begin. I understand that I
will continue to make my payment until I receive this conrmation and electronic withdrawals begin.
• I understand that this authorization and the program services in no way alter or lessen my obligation under my
existing mortgage contract regarding the amount of payments, when payments are due, the applications of
payments, the assessment of late charges, or the determination of delinquencies. I must maintain sufficient
funds in my account for withdrawal of my payment amount.
• I understand that withdrawn funds may not be applied to my mortgage until sucient funds have accumulated for a full
payment to be made.
• I understand that the electronic withdrawal amount will vary with changes in escrow or principal and interest components, if applicable.
• I agree to be bound by the program’s Terms and Conditions, which are stated here and online.
Automatic mortgage payment enrollment and change options
Note: We must receive notication at least three business days prior to any requests to temporarily stop, change or cancel
participation in automatic mortgage payments.
Can I do this by fax or mail? Can I do this online? Can I do this by phone?
Enrolling in automatic
payments
Yes. Yes, if you access your
mortgage online.
Yes.
Temporarily stopping
payments, canceling, or
making other changes
once I’m enrolled
Yes. You can cancel payments
online. To temporarily stop
payments or make other
changes, call us.
Yes.
How can I do this?
Fill out and sign this form.
Fax to: 1-866-287-6241
Or mail to:
Wells Fargo Home Mortgage
PO Box 10335
Des Moines, Iowa 50306
Sign on to your mortgage
account using the Wells
Fargo Mobile® app or at
wellsfargo.com.
Call us at 1-866-386-8519.
Note: There are two copies of the form, one for you to ll out and send to us, and one for you to keep with your records.
Page 1 of 2
Fill out this form and return to us using the instructions on page one, and keep a copy of this form with your records.
1. Select the automatic mortgage payment option that matches your pay schedule
Check the appropriate box to mark your choice. If this form is signed, but no option is checked, you will be set up for
monthly withdrawals on your due date.
If you choose the weekly or every-other-week option, withdrawals in addition to the amount needed to cover
your monthly mortgage payments will naturally occur 2 to 5 times per year. The additional withdrawn funds will
be automatically applied to your principal balance – helping you pay off your mortgage faster. For all options
below, the monthly payment includes principal, interest, tax, insurance, and escrow payments, if applicable.
Weekly: One-quarter of your monthly payment amount will be withdrawn every week. In a year’s time, 52 withdrawals
will be made.
Request a withdrawal start date (must be Mon. – Fri. and 4 weeks prior to due date): / /
Every other week (bi-weekly): Half of your monthly payment amount will be withdrawn every other
week. In a year’s time, 26 withdrawals will be made.
Request a withdrawal start date (must be Mon. – Fri. and 3 weeks prior to due date):
/ /
Twice a month (semi-monthly): Each withdrawal will equal one-half of the total monthly payment due. The full payment
must be withdrawn before the end of your grace period. Fill in the dates you would like for each half of your payment to be
withdrawn. Half of your monthly payment will be withdrawn on the of the month and
the second half will be withdrawn on the . In a year’s time, 24 withdrawals will be made.
Monthly: Your monthly payment amount will be withdrawn on your due date, or you can delay your monthly payment
up to 14 days after your due date. Mark below to select the number of days you would like to delay your payment.
Due date 1 day after 2 days after 3 days after Other (up to 14 days)
2. Specify additional principal to be withdrawn (optional)
Do you want to add an additional amount to each automatic payment? It will go directly to your outstanding loan principal,
if the loan is current. This will help you pay o your mortgage faster. If you want to do this, check the box below and let us
know how much you want to add.
Yes, please add $ to each of my automatic electronic withdrawals.
3. Supply your account information — You must be an owner on the deposit account
You can withdraw from up to 4 dierent accounts.
Account Type
(Checking or
Savings*)
Bank routing number
(9-digit number at
the bottom left of
your check)
Bank account number
(To the right of the
bank routing number
on your check)
Name on
bank account
Amount or % to be
withdrawn from
each account
(If you’re using more
than one account)
4. Signature
By signing below, I agree to the terms and conditions on the preceding page and online at wellsfargo.com/automaticpayterms. I also
certify that I own the account(s) above and that I’m a borrower on the loan number below.
Customer(s) name (print): Customer phone number:
Property address:
Customer loan number:
Customer signature:
Date signed:
Customer signature:
Date signed:
Note: This form must be received and processed within 120 days of the date it’s signed. Otherwise, we’ll need you to complete a new one.
* Other nancial institutions may assess excess activity fees on savings accounts. For more information, please refer to your account agreement with that nancial institution.
Wells Fargo Home Mortgage is a division of Wells Fargo Bank, N.A. 595909 (Rev 08/21) SVGv16 Page 2 of 2
© 2021 Wells Fargo Bank, N.A. All rights reserved. NMLSR ID 399801.