To make an Unearned Commission EFT Payment complete the form below. Please allow up to 2 business days for processing your request. 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 ad to debit the said account.Account Type*CheckingSavingsBank 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.)*Name on Bank Account*Agency Name*Agent Phone #*E-mail Address* Borrower / Insured Name*Policy #*Select one of the following:*My Account # begins with 1080My Account # begins with 1070My Account # begins with 1071Account #*Account #*Account #*UEC 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* First Last Date: 01/21/2021