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CREDIT CARD AUTHORIZATION FORM
NMLS# 191352
Borrower Name: Ali Mohammad Fouladgar
Loan Number: 2085M046105
Cardholder Name: ALI MOHAMMAD FOULADGAR
Billing Address: 440 CROSS RD APT C11, MATAWAN, NJ 07747
Card Type + Mastercard
Card Number: 4147 2021 6615 8699
Expiration Date:_/_98_/_22
Security Code (3-digit code on back of card): _981
By signing below, | certify that:
1. thave submitted a mortgage loan application to Bond Street Mortgage LLC
2. Ihave received my initial disclosures, including a Loan Estimate, and intend to proceed,
3. | authorize Bond Street Mortgage LLC to charge my card for $499.00 which is for an appraisal
fee. If the property is a condominium | understand that | also may be charged a fee in the
amount of $250.00 for Bond Street Mortgage LLC to obtain the necessary documents from the
HOA. In some cases, a re-inspection of the property is required and I understand | my credit card
may be charged for the service in the amount of $150.
4, The appraisal fee or condo HOA related charges will not be refunded if completed, it will be
refunded if the services are not completed.
I HAVE READ THIS CREDIT CARD AUTHORIZATION FORMAND | UNDERSTAND AND AGREE TO THE TERMS
AND CONDITIONS SET ABOVE.
Ot Mokammad Foutadgan
Ali Mohammad Fouladgar pave 99/22/2020
Bond Street Mortgage LLC (NMLS#191351, www.namlsconsumeraccess.org), for more licensing please
www.bondstreetloans.com/licensing
