Consumer Loan Payment

Please complete the fields shown below to authorize a consumer loan payment.

Loan Account Name (Primary/Secondary) *

First

Last

CBOTS Loan Account Number *

Account Holder Information

Name *

First

Last

Must be listed on loan account to make payment.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Payment Information

Source Bank Name *

Routing Number *

Deposit Account Number *

Source Deposit Account Owners *

Please list all owners of the source/funding deposit account. Loan customer must have ownership of this account to complete payment.

Account Type *

Checking
Savings

Payment Amount ($) *

Loan payoffs and principal only payments are not allowed with this form. Please contact your loan officer to discuss alternative options for these payment types.

Type of Payment *

One-time payment - Now
I would like to setup a recurring payment

Recurring Payment *

I want to setup a recurring payment with my first drafted payment being debited on the regularly scheduled payment date as outlined in my loan agreement.
I want to make a payment now and setup a recurring payment schedule with my next drafted payment being debited on the regularly scheduled payment date as outlined in my loan agreement.

Please note the payment you are authorizing now will be processed today and could clear you bank account as soon as tomorrow. Future reoccurring payments will be debited on the actual due date as outlined in your loan agreement. If authorizing recurring payments, I may cancel this agreement by giving CBOTS written notice. My notice must be received at least 5 days prior to the recurring scheduled payment that I wish to cancel and will apply to all future payments not processed or in process.

TERMINATION OF THIS AGREEMENT:
This Authorization will remain in full force and effect until Citizens Bank of the South has received written notification from you of its termination. You must provide notification to us, and we must receive your request at least 10 business days prior to the scheduled payment.

To revoke a preauthorized debit:
Please Call: 478.552.5116
Or Write To: PO Box 836, Sandersville, GA 31082

Email *

For security purposes, this email address must match the address listed on the account. Please contact Customer Service if you need to update the email address on file before submitting this payment.

Confirm Email *

Phone *

Approval *

I authorize Citizens Bank of the South to electronically debit the above account and apply this amount to the loan account listed above. I understand that I may be charged a fee by the funding bank in the event that funds are insufficient.

Please note: Payments made before 5pm will be posted to your account today with the payments possibly clearing your account on the next business day. Payments made after 5pm will post on the next business day.

Signature

Clear Signature

Please use your mouse, screen, or touchpad to sign above.

Once submitted you should receive an email verification.

Date of Signature

Please complete the fields shown below to authorize a consumer loan payment.

Account Holder Information

Payment Information

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