Mortgage Automatic Payment Form

and continuing on the same day each month thereafter until written Notice of Cancellation is provided per the terms stated.

I understand that by clicking submit, I hereby authorize Johnson Bank to process an automatic monthly transfer on my behalf from my deposit account at the financial institution named previously. I hereby authorize the amount to be transferred each month shall be the amount of the monthly mortgage payment at the time of the transfer. I further authorize variances in the amount of the monthly transfer as required under the terms of the Note. I may request cancellation of the automatic monthly transfer contemplated by this agreement upon notice at least 3 business days prior to the next scheduled transfer date. I may cancel the transfer verbally by calling 888.769.3796, or in writing by mailing Johnson Bank, PO Box 81368, Racine, WI 53408. If cancelling verbally, Johnson Bank must receive a written request within 14 days of the verbal notification to enforce the cancellation. Johnson Bank may cancel the Automatic Payment Option contemplated by this agreement upon written notice to you.