Get Advanta Payment Form

This Payment Authorization Letter shall be valid and in full force and effect until revoked in writing Print Name Signature Advanta IRA Date www. Advanta IRA Administration LLC 13191 Starkey Rd. Suite 9 Largo FL 33773 P 800 425-0653 F 866 385-6045 Payment Authorization Letter ACCOUNT HOLDER INFORMATION Name Your name as it appears in your plan Mr. Ms. Account Number Dr. PROPERTY INFORMATION Property Address/Asset Description Percentage of Ownership EXPENSE INFORMATION TYPE OF EXPENSE Taxes Taxing Authority Indicate below Insurance Company Indicate below Homeowner Association Dues HOA Name Indicate below Utilities Provider Indicate below Mortgage Lender Indicate below Amount to be Paid Other Specify Indicate below Refer to Invoice Frequency of Payments One Time Monthly Payment Beginning Date Quarterly Annually FUNDING INSTRUCTIONS Please send the funds for payment via For WIRE - Please complete the info below Bank Name Payment End Date As Invoiced WIRE CHECK ACH Please attach a voided check For CHECK - Please complete the info below Make Check Payable To Bank Phone ABA Routing Number Mail Check To Account Holder Name Address For Credit To City State Zip Send Check via Regular Mail Expedited 2nd Day Delivery 30 Certified Check 10 SIGNATURE AND ACKNOWLEDGEMENT I understand that my account is self-directed and that the Administrator serving from time to time as named in the Custodial Account Agreement or that entity s successor as Administrator and Custodian named in the disclosure statement received when the account was established will not review the merits appropriateness and/or suitability of any expense payment in general or in connection with my account in particular. I acknowledge that Administrator and Custodian do not endorse approve or recommend any companies products services or investments. I acknowledge that I have not requested that the Administrator and/or Custodian provide and neither Administrator nor Custodian has provided any advice with respect to the expense payment directive set forth in this Payment Authorization Letter. I understand that the Administrator and Custodian do not determine whether this payment is acceptable under the Employee Retirement Income Securities Act ERISA the Internal Revenue Code IRC Securities Laws or any applicable federal state or local laws. I understand that it is my responsibility to review any expense to ensure compliance with these requirements. I assume all responsibility in ensuring that Administrator Office and/or Custodian is provided with full payment instructions including but not limited to payment amounts due dates addresses of payees and account numbers. Ms. Account Number Dr. PROPERTY INFORMATION Property Address/Asset Description Percentage of Ownership EXPENSE INFORMATION TYPE OF EXPENSE Taxes Taxing Authority Indicate below Insurance Company Indicate below Homeowner Association Dues HOA Name Indicate below Utilities Provider Indicate below Mortgage Lender Indicate below Amount to be Paid Other Specify Indicate below Refer to Invoice Frequency of Payments One Time Monthly Payment Beginning Date Quarterly Annually FUNDING INSTRUCTIONS Please send the funds for payment via For WIRE - Please complete the info below Bank Name Payment End Date As Invoiced WIRE CHECK ACH Please attach a voided check For CHECK - Please complete the info below Make Check Payable To Bank Phone ABA Routing Number Mail Check To Account Holder Name Address For Credit To City State Zip Send Check via Regular Mail Expedited 2nd Day Delivery 30 Certified Check 10 SIGNATURE AND ACKNOWLEDGEMENT I understand that my account is self-directed and that the Administrator serving from time to time as named in the Custodial Account Agreement or that entity s successor as Administrator and Custodian named in the disclosure statement received when the account was established will not review the merits appropriateness and/or suitability of any expense payment in general or in connection with my account in particular. I acknowledge that Administrator and Custodian do not endorse approve or recommend any companies products services or investments.