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P.O.

Box 9500 Wilkes - Barre, PA 18773-9500

Account Number: 9191968414

AUTOMATIC (ELECTRONIC) DEBIT AUTHORIZATION


Agreement:
I, the Bank Account Holder, authorize Sallie Mae and its successors and assigns to initiate electronic debits from the bank account listed below in the amount of CLAUDIA ALZUGARAY (the Customer's) regular monthly student loan payment (as well as in the amount of any additional fees the Customer will incur if a debit transaction is unsuccessful as the result of having insufficient funds in my bank account) on or before the Customer's regular monthly payment due date, or in accordance with any future instructions that I provide, including verbal or electronic instructions. I, Bank Account holder, understand that if a payment is returned unpaid on the Customer's federal loan(s), I may be charged a fee for this returned payment and I authorize Sallie Mae to make a one-time electronic fund transfer from my bank account to collect the fee. I, the Bank Account Holder, understand that the Customer's regular monthly payment covers all of the Customer's loans now in repayment and serviced by Sallie Mae, as well as all the Customer's loans that are serviced by Sallie Mae that enter repayment in the future. If at any time I, the Bank Account Holder, want the electronic debits from my bank account to cover only part of the Customer's regular monthly payment, I will notify Sallie Mae by calling 888-272-5543 or writing to Sallie Mae at the address listed above. I understand that any changes to the amount deducted from my account via electronic debit will not be implemented until after I have received confirmation from Sallie Mae. I, the Bank Account Holder, understand that if the Customer's regular monthly payment amount is going to change, I will receive at least 10 days advance notice of that change. I, the Bank Account Holder, acknowledge and agree that I am responsible for overdraft, insufficient funds, and other service charges that my bank may impose in connection with the bank account listed below. I, the Bank Account Holder, understand that the Customer's regular monthly payments will be debited from the designated account even if other payments toward the Customer's loan(s) have been made and even if a monthly payment amount has been otherwise satisfied in full. I, the Bank Account Holder, authorize Sallie Mae, and its agents or assigns, to communicate with me in connection with this Automatic Debit Authorization or any of the Customer's current or future loans being serviced by Sallie Mae using any telephone number that I provide to Sallie Mae in this Authorization or in the future, even if such telephone number is associated with a cellular telephone. I authorize Sallie Mae to communicate with me using automated telephone dialing equipment and/or artificial or pre-recorded voice messages. This authority shall remain in effect until Sallie Mae receives notification from me (the Bank Account Holder) or the Customer of its termination by calling Sallie Mae at 888-272-5543 or writing to Sallie Mae at the address listed above or until the loan account has been paid in full. I understand that it may take as long as for Sallie Mae to process electronic debit cancellation requests, so I will make sure to notify Sallie Mae the date of the next scheduled automatic debit transaction.
10 days at least 10 days before

Section I: Bank Account Holder Information:


Name (as it appears on the bank account): ______________________________ Address: ___________________________ Phone Number:____________________ City/State: ______________________ Zip: ___________

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Account Number: 9191968414

Section II: Bank Account Information and Authorization:


Type of Bank Account (check one): (X) Checking ( ) Savings ABA Bank Routing Number*:
3 2 1 1 7 4 8 5 1 0000468988803 Bank Account Number: ____________________

*(Ninedigit number usually preceding bank account number.) Bank Account Holder Signature:______________________

Section III*: Customer (Borrower or Cosigner) Authorization for Forbearance:


*If your account is current, you do not need to complete this section. * If your account is past due you can bring your account current by making a payment to Sallie Mae or by signing this forbearance authorization section. NOTE: If you have private loans that are more than 60 days delinquent, you should not fill out this form. Instead you should call us at 888-272-5543. By signing below, I certify that I am past due on my loan payments due to financial circumstances and request forbearance to cover all my past due payments before automatic debit begins. As permitted by federal regulations, unpaid interest will be capitalized (added to my principal balance) as often as quarterly during the forbearance and at the end of the forbearance, even if my promissory note indicates otherwise. Unpaid interest on a Stafford loan disbursed on or after July 1, 2000 and on a private loan will be capitalized only at the end of forbearance. If I do not wish to have past due amounts covered by forbearance, I must remit payment to you to bring my account current prior to submitting this form.

Customer Name: CLAUDIA ALZUGARAY


Claudia M Butler Customer Signature: _______________________________________

Account Number: 9191968414


09/21/2011 Date: _________________

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