KELLY REMICK Chapter 13 Standing Trustee Middle District of Florida Tampa Division

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1 The Trustee offers an easy and convenient way to make monthly Chapter 13 payments if you have a fixed income, or get paid on the same days every month. We have the capability of automatically debiting your checking account each month for the amount of your Plan payment. This service may benefit you because: You won't have the worry about remembering to send your payments each month; You will save time and money since you won't have to run out to purchase and mail a money order or cashier's check each month; and Most importantly, you ll never have to worry about being behind in your Plan payments. However, if you do not get paid on the same days every month, our epay program may be more beneficial to you. Please see the enclosed epay quick reference guide for more information. Should you wish to participate in the automatic debit program, please return the completed authorization form to our office at the correspondence address below of P.O. Box 6099, Sun City Center, FL You may choose either the 5 th or the 17 th day of the month for your payment to be debited, regardless of your actual payment due date. Please be careful when filling out the authorization form, and make sure you fill out the appropriate form for the corresponding date you wish your payment to be debited out of your bank account. Please attach a voided check to the authorization form for whichever date you choose your debit to take place on. We cannot process debits without an attached voided check. After the Trustee receives and processes the authorization form, a written confirmation letter will be sent to you verifying the date on which the automatic debits will commence. In the event there is a change in your payment amount throughout the life of your plan, it is your responsibility to provide our office written consent authorizing us to debit the new payment amount each month. In addition, if you voluntarily dismiss or convert your case to another chapter or have completed all payments under your Chapter 13 Plan, you must notify us, in writing, to terminate these debits. These additional forms are attached in this packet and can also be found on our website. Mail payments to: P. O. Box 830, Memphis, TN Correspondence address: P. O. Box 6099, Sun City Center, FL Telephone (813) Toll Free Facsimile (813) Trustee Website:

2 If at any time an automatic payment is returned, you will be notified in writing. You will then be required to make the missed payment using a money order or cashier's check. You will also be required to reimburse our office for any fees our bank may charge. In addition, the agreement will be terminated, and this service will no longer be available to you. All future payments must thereafter be made in the form of a money order or cashier's check, or you may sign up for our epay program. Once this service has been established, there are 3 ways to terminate the automatic debit: 1. Your case is dismissed, converted to another chapter of the bankruptcy code, or upon completion of all Plan payments; 2. Your automatic payment is returned; or 3. You voluntarily terminate the agreement. There is a termination form attached to this letter. Please keep the termination form for future use. Once the Trustee receives a signed termination form, she will immediately terminate the automatic debits from your bank account and you then must go back to making all future Plan payments via money order or cashier's check, or you may sign up for our epay program. If you have any questions regarding either of these programs, please call our office and speak with someone in the Accounting Department. *** NOTE PLEASE SEND THE AUTHORIZATION TO THE CORRESPONDENCE ADDRESS, CHAPTER 13 STANDING TRUSTEE, P.O. BOX 6099, Sun City Center, FL ***

3 AUTHORIZATION Chapter AGREEMENT 13 Standing FOR Trustee I (we) hereby authorize Kelly Remick,, and/or any successor Trustee, hereinafter called TRUSTEE, to initiate debit entries in the amount of $ starting, and occurring on the 5 th day of each month thereafter, to my (our) bank account indicated below, and the depository named below, hereinafter called DEPOSITORY, to debit the same such account. In addition, I (we) hereby authorize TRUSTEE to debit our account for reimbursement of any fees incurred due to any returned items on my (our) account. ** Please allow a minimum of 10 days to process ** Bank Transit/ABA (Bank Routing) No: Note: The Transit/ABA number is a 9 digit number that is found on the bottom left of your check, before your account number. Please do not use a deposit slip to locate this number. This authority is to remain in full force and effect until TRUSTEE and DEPOSITORY have received written notification from me (or either of us) of its termination in such time and in such manner as to afford TRUSTEE and DEPOSITORY a reasonable opportunity to act on it. Case No: Date: Your phone number: PLEASE ATTACH A VOIDED CHECK BELOW:

4 AUTHORIZATION Chapter AGREEMENT 13 Standing FOR Trustee I (we) hereby authorize Kelly Remick,, and/or any successor Trustee, hereinafter called TRUSTEE, to initiate debit entries in the amount of $ starting, and occurring on the 17 th day of each month thereafter, to my (our) bank account indicated below, and the depository named below, hereinafter called DEPOSITORY, to debit the same such account. In addition, I (we) hereby authorize TRUSTEE to debit our account for reimbursement of any fees incurred due to any returned items on my (our) account. ** Please allow a minimum of 10 days to process ** Bank Transit/ABA (Bank Routing) No: Note: The Transit/ABA number is a 9 digit number that is found on the bottom left of your check, before your account number. Please do not use a deposit slip to locate this number. This authority is to remain in full force and effect until TRUSTEE and DEPOSITORY have received written notification from me (or either of us) of its termination in such time and in such manner as to afford TRUSTEE and DEPOSITORY a reasonable opportunity to act on it. Case No: Date: Your phone number: PLEASE ATTACH A VOIDED CHECK BELOW:

5 AUTHORIZATION FOR TERMINATION OF I (we) hereby authorize Kelly Remick,, and/or any successor Trustee, hereinafter called TRUSTEE, to terminate debit entries from my (our) bank account indicated below, and the depository named below, hereinafter called DEPOSITORY, to terminate debit entries from the same such account. Effective Date: Bank Routing No: Case No: Date: Date: Attention: Nancy 5 th Nicole 17 th Ext. 133 Ext. 132 Mail payments to: P. O. Box 830, Memphis, TN Correspondence address: P. O. Box 6099, Sun City Center, FL Telephone (813) Toll Free Facsimile (813) Trustee Website:

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