Authorization to Charge
Credit/Debit Card
Broker (Company)Borrowers
Property Street Address
PropertyCity / PropertyState / Property Zip Code
Authorization to Pay Appraisal Fee with Card Account (from authorized Card Holder)
1. As the undersigned Card Holder, you are responsible for paying the appraisal fee for this appraisal with your card account. You are giving authorization to Mid-Island Mortgage Corp. to charge your card account for the invoiced amount of your appraisal order as submitted by Mid-Island Mortgage Corp.
Mortgage. NOTE: If you are the borrower, the authorization on your card will not be processed until the fourth business day after a truth-in-lending disclosure has been mailed to you from Mid-Island Mortgage Corp.Below is an estimated appraisal fee schedule. The categories are estimates only. The amount invoiced and provided by the appraisal vendor is the amount that will be charged to your card account by Mid-Island Mortgage Corp.
Single Family / Condo / 2 Unit / 3 Unit / 4 Unit
$450 – for loans up to $500,000 / $600 / $600 / $750 / $850
$500 – for loans above $500,000
2. Acceptable cards are Visa and MasterCard. If your card account is declined, the appraisal will be held until a card account can be charged.
3. Appraisal orders will be placed with an approved service provider. You will not pay the appraiser directly.
4. The appraisal fee is not dependent in any way on a pre-determined value estimate or upon the closing of the loan. Paying an appraisal fee does not guarantee that a loan product will be available and/or that a loan will fund. Appraisal fees are non-refundable.
5. You will be responsible for paying any appraisal fees generated prior to cancellation (such as, trip and cancellation fees).
Name as it Appears on Card / Card Number / Card Expiration (MM/YY)
Select One: Visa MasterCard
Email Address / Billing Phone Number
Billing Street Address
BillingCity / BillingState / Billing Zip Code
Card Holder is: an employee of the Broker Company noted above a borrower on the loan noted above
Authorized Card Holder (signature) / Date
By signing above, you (the Card Holder) confirm that: (a) you are an authorized signer on the card account presented above for the payment ofthis appraisal, (b) you understand and agree to the appraisal terms as detailed above, (c) you authorize Mid-Island Mortgage Corp. to engage an appraiser on yourbehalf to appraise the property noted above, (d) you agree to pay the appraisal fee for this loan when charged, and (e) you acknowledge that acharge back issued against any payment transaction will be considered a non-payment of the appraisal charge and a breach of the paymentguarantee noted above. You further agree to contact Mid-Island Mortgage Corp in aneffort to resolve any transaction discrepancies or errors, should they arise, prior to contacting your financial institution.
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