HTML Preview Payment Authorization Letter page number 1.
Quest IRA, Inc.
17171 Park Row, Suite 100
Houston, TX 77084
P: 800.320.5950
F: 281.646.9701
Page 1 of 2
Payment Authorization
Letter
ACCOUNT HOLDER INFORMATION
Your Name:
Account Number:
Asset Name:
Percentage of Ownership (if not specified, 100% will be paid):
PLEASE PAY THE FOLLOWING INVOICE
Payment of:
Mortgage Property Taxes Insurance Utilities
HOA dues Other:____________________________________________
Frequency of payments (If not specified, this will be processed as a one-time payment):
One Time As invoiced Monthly Quarterly
Semi-Annually Annually
Amount to be sent: _________________________________________ or Amount as invoiced
PAYMENT INFORMATION
Pay the invoice via:
Wire ($30 processing fee. Please include outgoing wire instructions)
ACH Transfer ($5 fee. Please provide instructions)
Check ($5 fee) Payable to: _________________________________________________________________________
Mail to: ________________________________________________________________________________________
Mailing Options:
United States Postal Services (No Charge) Overnight Mail ($35 fee, FedEx Overnight)
AUTHORIZATION:
I am directing the Administrator to complete the transaction(s) as specified above. I agree to indemnify and hold harmless the
Administrator and the Custodian from any and all claims, damages, liability, actions, costs, expenses (including reasonable attorneys’
fees) and any loss to my account as a result of any action taken in connection with any payments covered by this Payment
Authorization Letter. I assume all responsibility for ensuring that the Administrator is provided with full payment instructions
(including, but not limited to, payment amounts, due dates, addresses of payees and account numbers). I understand that if this
Payment Authorization Letter and any accompanying documentation are not received as required, or, if received, are unclear in the
opinion of the Administrator, or if there is insufficient Undirected Cash in my account to fully comply with my instructions to pay the
bills and all fees, the Administrator may not process this transaction until proper documentation and/or clarification is received, and
the Administrator will have no liability for late fees or loss of income. I declare that I have examined this document, including
accompanying information, and to the best of my knowledge and belief, it is true, correct, and complete.
AUTHORIZED BY:
Account holder ____________________________________ ______________
Limited power of attorney Signature (Required) Date