VIHFA Credit Card Authorization Agreement Form
VIRGIN ISLANDS HOUSING FINANCE AUTHORITY 3202 Demarara No. 3+ Frenchtown Plaza - Suite 200 + St. Thomas, USVI 00802 Telephone (340) 777-4432 + Fax: (340) 775-7913 Email: vihfa@vihfa.gov CREDIT CARD AUTHORIZATION AGREEMENT (PLEASE PRINT OR TYPE INFORMATION) NAME: ACCOUNT NUMBER: I hereby authorize the VIRGIN ISLANDS HOUSING FINANCE AUTHORITY, hereinafter called the AUTHORITY, to charge my credit card in the amount of $ each month for the payment of my account (loan/rent) listed above for the duration of the term. By signing this documentation, you are agreeing not to dispute or cancel these charges. This authorization is to remain in full effect unless written notification to cancel is received by the AUTHORITY. A fax copy of this authorization is not allowed. Requirements: A legible copy of the front and back of the credit card and your picture ID. This request can only be made by the cardholder of said account. PLEASE CHECK ONE: [_)] VISA (_)] MASTERCARD Date of Payment: LO} 5th o) Exact name as shown on card Credit Card Number / / Expiration Date CID No. …
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VIRGIN ISLANDS HOUSING FINANCE AUTHORITY 3202 Demarara No. 3+ Frenchtown Plaza - Suite 200 + St. Thomas, USVI 00802 Telephone (340) 777-4432 + Fax: (340) 775-7913 Email: vihfa@vihfa.gov CREDIT CARD AUTHORIZATION AGREEMENT (PLEASE PRINT OR TYPE INFORMATION) NAME: ACCOUNT NUMBER: I hereby authorize the VIRGIN ISLANDS HOUSING FINANCE AUTHORITY, hereinafter called the AUTHORITY, to charge my credit card in the amount of $ each month for the payment of my account (loan/rent) listed above for the duration of the term. By signing this documentation, you are agreeing not to dispute or cancel these charges. This authorization is to remain in full effect unless written notification to cancel is received by the AUTHORITY. A fax copy of this authorization is not allowed. Requirements: A legible copy of the front and back of the credit card and your picture ID. This request can only be made by the cardholder of said account. PLEASE CHECK ONE: [_)] VISA (_)] MASTERCARD Date of Payment: LO} 5th o) Exact name as shown on card Credit Card Number / / Expiration Date CID No. (See below) Cardholder’s Signature & Date 000011112222333%099) —a> Iaeretification VISA Billing address of Cardholder Daytime Telephone No. Physical address of Cardholder St. Croix Office: Frits Lawaetz Complex: Suite 210- Frederiksted, St. Croix V1 00840 - Telephone (340) 772-4432 TERMS OF AGREEMENT Please ensure that you have read the following before signing the Credit Card Authorization Agreement. Please retain a copy of this page for your records. e The Authority may vary this agreement at any time by giving you at least 15 days notice. e By signing a Credit Card Authorization, you request and authorize the Authority to arrange for funds to be debited from your account as provided in this Authorization Agreement. The amounts drawn will be in accordance with your coupon or any greater amount which you, or either of you, instruct the Authority to draw. The Authority will arrange for funds to be debited from your account: e as requested and authorized in the Credit Card Authorization Agreement; and e inaccordance with this Agreement. The payment will be deducted from your nominated account on the 1” or the 15th of the month. If this date falls on a non-working day or a federal or local holiday, the payment will be processed on the next business day. It is your responsibility to ensure that you have sufficient funds in the nominated account when payments are to be drawn. If you do not have sufficient funds, then: e the payment will be regarded as not having been made; ¢ a processing fee will be charged to your account in the amount of $50.00 along with the late fee; e and you are required to visit the office and make the payment along with any other fees that have been accrued as a result. If you believe that there has been an error in debiting your account you should contact the Collections & Servicing Division at (340) 777-4432 or 772-4432 between the hours of 8am to 4pm, Monday to Friday so that we may resolve your query quickly. Your records and account details will be kept private and confidential and will only be disclosed at your request or the request of the financial institution in connection with a claim made to correct an alleged incorrect or wrongful debit or otherwise as required by law. - I/We have read the terms of the Credit Card Authorization Agreement. Initial(s) / Date: / /