Remittance Coupon form

ACH Remittance Form Design

Screen 1 - Enter LaRS Payment Information Form

Pay Via Bank Account (ACH)

New

Lender Name: Payment Status:

Confirmation Number:

System date

Transaction Date: Payment Date:

Payment Amount:

Account Type:

Routing Number:

Account Number:

Error Code and Message:

Error Detail:

Submit Payment

Cancel

Note: All fields will be pre-populated with the exception of the Routing & Account Number (highlighted in yellow). The lender will be responsible for completing those fields.

Screen 2 - Enter CLRF Payment Information Form

Pay Via Bank Account (ACH)

New

Lender Name: Payment Status:

Servicer Name: Confirmation Number:

Reporting Period: MM / YY

Consolidation Loans Subject to the 1.05% fee; applicable rate: 0.000875

Number of Loans:

End-of-Month Principal Balance:

EOM Accrued Unpaid Interest Balance:

Consolidation Loans Subject to the 0.62% fee; applicable rate: 0.0005167

Number of Loans:

End-of-Month Principal Balance:

EOM Accrued Unpaid Interest Balance:

Total Consolidation Loan Rebate Fee

System date

Transaction Date: Payment Date:

Payment Amount:

Business Checking

Account Type:

Routing Number:

Account Number:

Error Code and Message:

Error Detail:

Submit Payment

Cancel