Onetime Payment EFT

To make a Onetime Payment EFT complete the form below. Please allow up to 2 business days for processing your request.

For Faster Processing, please login to your account and submit a payment before our 2:00 PM CST cutoff.

I (we) hereby authorize Stonemark Holdings, Inc., hereinafter called Lender, to initiate debit entries to the checking/savings account, depository name (hereinafter called DEPOSITORY) below and to debit the said account.

Form Completed By:
Agent / BrokerBorrower / Insured

Select Bank Account to Debit:
Agent / BrokerBorrower / Insured

Account Type
CheckingSavings

Bank Name

Bank Routing Number
(Please double check your entry to avoid possible return fees. It MUST be 9 digits.)

Bank Account Number
(Please double check your entry to avoid possible return fees.)

Verify Bank Account Number

Name on Bank Account

Borrower / Insured Name

Phone #

Email Address

Select one of the following:
Account # (begins with 1080)Quote Number

Account #

Quote Number

Payment Amount
$

I (we) hereby authorize Stonemark Holdings, Inc., to use this information on this account as a payment and to use this information to make a onetime electronic funds transfer from my account or to process the payment as an electronic transaction. I am an authorized signer or authorized representative of the account, and have signed this sheet to certify this transaction.

Electronic Signature of Authorized Signer on bank account

First

Last