Print this form and follow the steps. Fax to 713-228-4129

______________________________________________________________________________________

Step 1 -Social Security Card and I. D. Card

Step 2 - A Recent Pay Check Stub

Name:__________________________________________

Address:________________________________________

City:_______________________ State____________

Phone: (_________) - _______________-______________

 

Name:__________________________________________

Address:________________________________________

City:_______________________ State____________

Phone: (_________) - _______________-______________

___________________________________________________________

Name:__________________________________________

Address:________________________________________

City:_______________________ State____________

Phone: (_________) - _______________-______________

___________________________________________________________

Name:__________________________________________

Address:________________________________________

City:_______________________ State____________

Phone: (_________) - _______________-______________

___________________________________________________________

Name:__________________________________________

Address:________________________________________

City:_______________________ State____________

Phone: (_________) - _______________-______________

___________________________________________________________

Name:__________________________________________

Address:________________________________________

City:_______________________ State____________

Phone: (_________) - _______________-______________

Step 3 - Six Personal Reference Name, Address, and Phone Number
Place your I. D. and Socal on top of the example cards
Fax your pay check stub
Fill in your personal reference name, address, & phone number
The right column instructions will not show up on printed paper

I (we) hereby authorize Houston Finance Co. Inc. 405 Main Suite b-101 Houston, Texas 77002 hereinafter called Company, to initiate debit entries to my (our) ____ Checking ____ Savings account (select one) indicated below, and the depository named below, hereinafter called Depository, to debit the same to such account.

Depository (Bank) Name- ______________________________________

Transit/Routing No.-_________________________________ Account No-_________________________________

Amount of each debit $______ on the ______ of each month starting ______________ and Ending _______________

Name(s) _____________________________ Date ____________Signed (x)________________________________

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

_____________________________________________________________________________________

Authorization Agreement For Preauthorized Payments (ACH Debits)
Step 4 - Fill In Your Authorization Forum
Name______________________________ Due____________
Company Use Only
Finally Fill out the auto debit form and fax to 713-228-4129
Fax to 713-228-4129

What You Need To Bring In

______________________________________________________________________________________