Borrower Application Acknowledgement and Payment Authorization Certificate
Borrower(s) Name(s):
Date:
Address:
City:
State:
Zip:
Plan Number:
Application ID:
Merchant:
Card Account Number (last 8 digits):
Exp. Date:
| Payment Authorization Schedule | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Amount | Authorization Date | Project completion stage | Borrower(s) Initials | ||||||||||
| Payment/Transaction | $ | ||||||||||||
For Final Payment: Signed proof of project completion to be provided to GreenSky upon request.
By signing below, I/we, the Borrower(s):
- Acknowledge submitting an application for a loan with a participating financial institution in the GreenSky® Program;
- Acknowledge receipt of the GreenSky® loan agreement ("Agreement") with the lender specified on the Agreement ("Lender") and agree to be bound by the Terms and Conditions of the Agreement;
- Authorize the payments in the schedule above subject to mutually agreed upon completion of project stage;
- Instruct our Lender to disburse the proceeds of the GreenSky® loan to the Merchant identified above in the Amount(s) specified in the Payment Authorization Schedule.
The signature of a Borrower(s) below will constitute the authorization by all Borrowers to process the transaction(s) as identified in the Payment Authorization Schedule above.
Borrower Printed Name:
Signature:
Co-Borrower Printed Name:
Signature: