Loan Agreement and Electronic Consent Guide
Loan Agreement and Electronic Consent Guide
1. Attention Statement
2. Consent to Electronic Disclosures and Electronic and
Telephone Communications
3. SMS/Text Messaging Consent (with Agreement re:
telemarketing texts)
4. Privacy Policy
5. Installment Loan Agreement and Truth-in-Lending Disclosure
6. Amortization Schedule
7. Optional Revocable Payment Authorization
8. Optional Revocable Electronic Fund Transfer and Debit Card Payment Authorization ("Debit Card
Payment Authorization")
9. Military Affidavit
**ATTENTION**
You can pay this loan off at any time. You will only pay interest for the days you have the loan
outstanding. The Optional Revocable Payment Authorizations for electronic payments are not required to
obtain a loan, however if you are unable to sign any provision of the following agreement, please call us to
complete your loan.
In the paragraphs below the words "you" and "your" mean each customer ("BORROWER") so named below?
the words "we", "us", and "our" mean Galt Financial Solutions, LLC, which is the "LENDER" in this
transaction.
ELECTRONIC SIGNATURE: You acknowledge and agree that when you type your name in the boxes
indicated on this application for a loan, and click the "Continue" button, you are providing your electronic
signature on this application for a loan with Galt Financial Solutions, LLC (“Galt”, the Company or Lender)
and/or its affiliates or agents which is the same as if you signed a paper copy, in accordance with the Electronic
Signatures in Global and National Commerce Act and the Missouri Statutes and Uniform Commercial Code. By
electronically signing this application, you are agreeing to all the terms and conditions set forth below in this
application if accepted. Your consent does not guarantee acceptance of your application for credit.
CONSENT TO BE CONTACTED: By providing your contact information, phone number and requesting a
loan, You are expressly consenting to be contacted by the Company, its affiliates, Customer Services
Representative or other agents of the Company us by telephone, email or text/SMS messages or mailing
addresses in our records or from other public or non public data bases we may have lawful access and in
connection with any such telephone calls, you consent to the use of pre-recorded/artificial voice message and/or
automatic dialing devices, at any telephone number associated with your account, including mobile telephone
numbers that could result in charges to you for matters related to your account, loan, payments on your account
or application even if you have opted into the national Do Not Call List administered by the Federal Trade
Commission, any state equivalent Do Not Call List or the Do Not Call List of any specific institution. The
Company or its representatives can contact you for the services of your loan servicing, regarding the application,
for anything related to your loan or application including reminders of your payments, collections and other
loan-related issues. You further agree and acknowledge that we may use third party services and other providers
The following terms and conditions govern electronic communications and disclosures in connection with this
Agreement and the transaction evidenced hereby (the "Consent"). By this Agreement, you agree that any notices
we are required to make to you may be delivered to you electronically. In addition, you expressly consent to the
Company contacting you at any phone number listed on your application or contract, including home address or
email address provided on this document, updated by you or provided by your references in the future, or
ascertained by the Company through its resources. You acknowledge and agree to the following terms and
conditions of this Consent and that you have received a copy of this Consent for your records. You agree that:
i. Any disclosure, notice, record or other type of information that is provided to you in connection with your
transaction with us, including but not limited to, this Agreement, this Consent, the Application, any
change-in-term notices, fee and transaction information, statements, delayed disbursement notices, notices
of adverse action, state mandated brochures and disclosures, and transaction information
("Communications"), may be sent to you electronically by posting the information at our website,
provided in this agreement, or by sending it to you by email.
ii. You have the option to receive any information that the Lender has provided electronically in paper form
at no cost to you by contacting the lender in writing at this Address: 539 W. Commerce st #6510, Dallas,
Texas 75208 (please including your name, address, and Loan Number) or by calling us at: 888-743-6229.
You can also withdraw your consent to ongoing electronic communications in the same manner.
iii. You agree to provide us with your current email address for notices at the email address or phone number
as indicated at the top of the Loan Agreement. If your email address, telephone number(s), or residences
address changes, you must send us a notice of the new address/telephone number(s) by writing to us or
sending us an email, at least five (5) days before the change.
iv. In order to receive electronic communications, you will need a working connection to the Internet and an
email account. . Your browser must support the current version of Secure Sockets Layer (SSL) protocol.
You must have a printer or sufficient hard drive space available to save the information. If you have a
question about your browser and the SSL protocol, please contact your Internet Service Provider or a
qualified information technology service provider. Generally to electronically receive, view and save or
print the Disclosures, you must have a personal computer equipped with Microsoft Internet Explorer 7.0,
Google Chrome 13.0, Firefox 5.0, Safari 4.0 or any later version of these programs, Adobe Reader 6 or
later version? and either a printer, a hard drive or other storage device. We recommend that you print a
paper copy of your loan documents and notices or save a copy.
v. We may amend (add to, delete or change) the term of this Consent by providing you with advance notice.
BY CLICKING YOU AGREE BELOW, YOU ACKNOWLEDGE THAT YOU HAVE READ,
UNDERSTAND AND AGREE TO BE BOUND BY THE ABOVE CONSENT. IF YOU DO NOT
AGREE, YOU WILL NOT BE PERMITTED TO OBTAIN CREDIT SERVICES OR A LOAN.
Under the Federal E-Sign Act (E-Signature Act) the typing of your name along with your IP address and time
stamp is the same as you physically signing this document in person.
[sig|req|signer0]
1. How to Unsubscribe: You may withdraw your consent to receive SMS Statement Notifications by calling
us at Lender’s phone number provided in the Loan Agreement. We will not impose any fee to process the
withdrawal of your consent to receive SMS Statement Notifications. Any withdrawal of your consent to
use SMS Statement Notifications will be effective only after we have a reasonable period of time to
process your withdrawal.
2. To request additional information regarding text messaging call us at the Lender's or the Company's phone
number provided in the Loan Agreement.
3. The services are available on all major carriers. Additional carriers are added as they become available.
4. In order to access, view, and retain SMS Statement Notifications that we make available to you, you must
have: (1) a SMS-capable mobile phone/device, (2) an active mobile phone/device account with a
communication service provider? and (3) sufficient storage capacity on your mobile phone/device.
5. All SMS Statement Notifications in electronic format from us to you will be considered "in writing".
6. There is no service fee for SMS Statement Notifications but you are responsible for any and all charges,
including but not limited to fees associated with text messaging, imposed by your communications service
provider. Other charges may apply. Such charges may include those from your communications service
provider. Please consult your mobile service carrier's pricing plan to determine the charges for sending and
receiving text messages. These charges will appear on your phone bill. Message frequency depends on
account settings.
7. Additionally, you agree that we may send any SMS Statement Notifications through your communication
service provider in order to deliver them to you and that your communication services provider is acting as
your agent in this capacity. You agree to provide a valid mobile phone number for these services so that
we may send you certain information about your account. Additionally, you agree to indemnify, defend
and hold us harmless from and against any and all claims, losses, liability, cost and expenses (including
reasonable attorneys' fees) arising from your provision of a mobile phone number that is not your own or
your violation of applicable federal, state, or local law, regulation or ordinance. Your obligation under this
Receipt of each SMS Statement may be delayed or impacted by factor(s) pertaining to your
communications service provider(s) or your use or non use of your SMS Device. We will not be liable for
losses or damages arising from any disclosure of account information to third parties, non-delivery,
delayed delivery, misdirected delivery or mishandling of, or inaccurate content in, the SMS Statement
Notifications sent by us.
8. We may modify or terminate our text messaging services from time to time, for any reason, and without
notice. Please review these Terms of Use from time to time so that you are timely notified of any changes.
By providing your cell phone number, you have provided us with consent to send you text messages in
conjunction with the services you have requested. Your cellular provides message and data rates may apply to all
messages. You understand that text message we send may be seen by anyone with access to your phone/device.
Accordingly you should take steps to safeguard your phone device and text messages if you want them to remain
private.
By signing this section, you authorize Us, the Lender and the Company to send marketing text messages to the
mobile number you have provided and that is listed on this Agreement using an automatic telephone dialing
system. You are not required to authorize marketing text messages to obtain credit or a loan from us. If you do
not wish to receive sales or marketing text messages from us, you should not sign this section. You understand
that any messages we send you may be accessed by anyone with access to your text messages or phone/device.
You also understand that your mobile phone service provider may charge you fees for text messages that we
send you. You agree that we shall have no liability for the cost of any such text messages. You may withdraw
your consent to receive marketing text messages at any time by either calling us, or replying STOP to any
marketing text message that we send you.
Under the Federal E-Sign Act (E-Signature Act) the typing of your name along with your IP address and time
stamp is the same as you physically signing this document in person. Further you have previously consented to
the use of e-signatures and electronic communications.
How? All financial companies need to share customers' personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers'; personal information? the reasons COMPANY chooses to share? and whether you
can limit this sharing.
Reasons we can share your personal Does the To Whom is information shared with?
information Company
share? Can you limit this sharing?
For our everyday business purposes - such as to Yes Third Party Processors and providers who have
process your transactions, maintain your contractual duty of confidentiality, to courts
account(s), respond to court orders and legal pursuant to a court order and major consumer
investigations, credit reporting agencies andcredit bureau.
or report to credit bureaus
No
For our marketing purposes - to offer our Yes Third Party Processors and providers who have
products and services to you contractual duty of confidentiality
Why can't I limit all sharing? Federal law gives you the right to limit only
State laws and individual companies may give you additional rights to
limit sharing. See below for more on your rights under state law.
What happens when I limit sharing for an Your choices will apply to everyone on your account.
account I hold jointly with someone else?
Definitions
Affiliates Companies related by common ownership or control. They can be
financial and nonfinancial companies.
Our affiliates include financial companies operating under the Galt
Financial Solutions, LLC or its affiliates.
Please note:
If you are a new customer, we can begin sharing your information for
business purposes immediately. We will not share your information to
unrelated companies for the purpose of marketing their goods and
services to you for 30 days from the date we sent this notice. When
you are no longer our customer, we continue to share your
information as described in this notice. However, you can contact us
at any time to limit our sharing as provided for in this privacy
policy allowing us enough time to process your request.
Questions Call 888-743-6229. Or Email: support@[Link].
PAYMENT SCHEDULE:
No. Date Amount No. Date Amount No. Date Amount
1 25 Oct 2024 $156.02 5 20 Dec 2024 $156.02 9 14 Feb 2025 $156.02
2 8 Nov 2024 $156.02 6 3 Jan 2025 $156.02 10 28 Feb 2025 $156.02
3 22 Nov 2024 $156.02 7 17 Jan 2025 $156.02 11 14 Mar 2025 $156.02
4 6 Dec 2024 $156.02 8 31 Jan 2025 $156.02 12 28 Mar 2025 $155.81
SECURITY: If provided, the "Optional Revocable Payment Authorization Agreement(s) are security for this
loan.
LATE PAYMENT: If a payment is 15 days late, you may be charged 5.00% of the unpaid portion of the
payment or $15.00 whichever is greater. If the payment is $25 or less, the maximum late fee will be $5.00
PREPAYMENT: If you pay off early, you will not have to pay a penalty.
See the information below and on additional pages for additional information about contract terms,
nonpayment, and default.
Itemization of the Amount Financed of: $600.00 Itemization of the Total Finance Charge of: $1,272.03
1. Amount paid directly to you: $600.00 1. Interest Charge: $1,272.03
2. Amount paid on previous loan: $0.00 2. Origination Fee Charge: $0.00
3. Total Amount Financed: $600.00 3. Total Finance Charge: $1,272.03
PROMISE TO PAY: You Promise to pay to Lender, the principal sum of $600.00 plus interest at the Interest
Rate referenced above per annum until the loan is paid in full. The loan is payable in installment payments as
referenced above in the Payment Schedule.
ATTORNEYS' FEES: You agree that in the event you default in performing any of your obligations under this
Agreement you shall pay all lawful collection costs and court costs associated with your default, including costs
and reasonable attorney's fees in the amount permitted pursuant to section 408.140 RSMO.
DEFAULT: You will be in default under the Agreement if, for any reason, you fail to make payment in the full
amount required by this Agreement on the date due. If you fail to make the final installment payment, you
understand that interest will continue to accrue on any remaining unpaid balance at the interest rate agreed to
under this Contract disclosed above until the loan is paid in full or until entry of judgment. After the entry of
judgment, interest will accrue at the maximum amount allowed by law.
ACCELERATION: In the event of default on the loan, the lender may, after providing all notices required by
law, demand payment in full at once. Interest will accrue at the rate agreed to under this contract until your loan
is paid in full or a judgment is entered. If a judgment is entered, interest will accrue at the rate set by Missouri
statute.
RETURNED CHECK/ACH or DEBIT CHARGE FEE: You agree to pay to LENDER the amount of $25.00
if the ACH or debit card with which you make your payment is refused
or returned.
LATE CHARGES: If a payment is 15 days late , You may be charged a fee of 5.00% of the unpaid portion of
the payment or $15.00 whichever is greater. If the payment is $25 or less, the maximum late fee will be $5.00
PAYMENTS: All payments will be applied first to interest, then to fees or charges due to us, and then to
principal.
CONSUMER REPORTS: You authorize us to obtain customer reports about you prior to issuing a loan under
this Agreement, and at any time that you owe us money under this or any other Loan Agreement.
GENERAL PROVISIONS: Pursuant to Comment 2(a)(25) of the Official Staff Commentary to Regulation Z
§226.2, we have disclosed to you that our interest in the ACH Agreement is a security interest for federal Truth-
in-Lending purposes only. However, this disclosure is not intended to create a security interest under Missouri
law and shall not be evidence of or an admission by the Lender that this transaction is anything other than a
transaction authorized by the Missouri law. Time is of the essence in this Agreement.
BANKRUPTCY: You certify to us that you are not a debtor under any proceeding in bankruptcy and
have no intention to file a petition for relif under any chapter of the United States Bankruptcy Code.
PREPAYMENT: You have a right to prepay this loan in full by cash, renewal, refinancing, or a new loan and
WAIVER: No waiver of your or our rights is effective unless in writing. No written waiver for any one situation
shall apply to any other situation. If either you or we fail to exercise or delay in exercising any right or remedy,
this will not constitute a waiver of that or any other right or remedy.
SEVERABILITY: If any provision of this Agreement or the application of any provision of this Agreement to
any person, place or circumstance shall be determined to be invalid, unenforceable or void, the remainder of the
Agreement, and the remainder of those provisions of this Agreement as applied to other persons, places and
circumstances, shall remain in full force and effect.
GOVERNING LAWS: The Agreement shall be construed in accordance with and governed by federal law with
respect to the Arbitration Agreement and the laws of the State of Missouri, without giving effect to any choice of
law rule.
1. You acknowledge that it was complete without missing information and that you have received a
completed copy of it.
2. You agree that the information you provided to us prior to entering into this loan agreement is accurate.
3. You agree that you are over 18 years of age.
4. You agree that you have the financial ability to repay this loan agreement, based upon your current and
expected income, obligations, and employment.
If you do not wish to sign the Consumer Loan Agreement and Disclosures and the other documents, you may
close this browser page. If you chose not to sign the documents, the transaction will not be processed and there is
no cost to you. If you do not wish to sign them electronically, you may also print these documents out and sign
them and return them to us. By signing this Agreement, you further acknowledge that you have read and
understand the Statement on Consumer Consent to the Use of Electronic Transactions, Signatures and Records.
Under the Federal E-Sign Act (E-Signature Act) the typing of your name along with your IP address and time
stamp is the same as you physically signing this document in person. Further you have previously consented to
the use of e-signatures and electronic communications.
PAYMENTS DUE
By signing below, you agree to the Jury Trial Waiver and Arbitration Clause (“Clause”). THIS ARBITRATION
AGREEMENT IS BETWEEN MATTHEW HEIRONIMUS (“You” or “Your”), and Galt Financial Solutions,
LLC ("Lender"). This Arbitration Agreement applies to all of your Loan Agreements, including but not limited
to Your Application, Privacy Policy, Consent to Electronic Delivery of Disclosures and Documents, Optional
Revocable Authorization Agreements, Installment Loan Agreement and Disclosures, and any other Agreements
or transactions in connection with your Application and your Loan. No. 207998 on 2024-10-08, (collectively
“Customer Documents”).
In arbitration, a third party (“Arbiter”) resolves Disputes in a hearing (“hearing”). You, related third parties and
the Lender waive the right to go to court including the right to have a jury trial. The hearing is typically private
and less formal than court. Arbiters may limit pre-hearing fact finding, called “discovery.” The decision is final.
Courts rarely overturn Arbiters. The Agreement to Arbitrate will require all parties to arbitrate including, you,
us, the Lender, related third parties, heirs, successors and assigns.
This Clause governs all types of “Disputes” involving the parties. This includes all claims even indirectly related
to your Customer Documents with us and the Lender. This includes: i) claims related to information you
previously gave us, ii) all prior agreements, iii) extensions, renewals, refinancings, or payment plans, iv) claims
related to collections, privacy, and customer information, v) claims related to collection of amounts owed
pursuant to the Customer Documents, vi) claims related to setting aside this Agreement and vii) claims about the
Agreements validity and scope and whether to arbitrate.
By signing below, please be aware that you are waiving your rights to: i) Have a jury trial to resolve
Disputes, ii) Have courts, other than small-claims courts, resolve Disputes, iii) Serve as a private attorney
general or in a representative capacity, and iv) Be in a class action (except where such waiver is not
permitted by law).
You waive your rights to participate in a class action lawsuit, as a representative and a member. Only individual
arbitration, or small-claims courts, will resolve Disputes. You waive your right to have representative claims.
The Federal Arbitration Act (“FAA”). This transaction involves interstate commerce, so the FAA governs. If a
court finds the FAA doesn’t apply, and the finding can’t be appealed, then your state’s law governs. The Arbiter
must apply substantive law consistent with the FAA. The Arbiter must follow statutes of limitation and privilege
claims.
Lender will use all reasonable efforts to resolve Disputes if you call us at 888-743-6229. If this doesn’t resolve
the Dispute, please send mail to the Lender within 60 days of the Dispute date. In your notice, tell Lender the
specifics and how you want to resolve the Dispute it and the Parties will make every effort to resolve the
Dispute. If the dispute does not get resolved, either party may initiate arbitration. To initiate arbitration, contact
an Arbiter or arbitration group listed below.
The Agreement stays effective unless the parties sign an agreement stating it doesn’t. The Agreement governs if
you rescind the transaction. It governs if you default, renew, prepay, or pay. It governs if your contract is
discharged through bankruptcy. The Agreement remains effective, despite a transaction’s termination,
amendment, expiration, or performance.
Each party has the right to arbitrate, or to go to small-claims court if the small-claims court has the power to hear
the Dispute. Arbitration will resolve all Disputes that the smallclaims court does not have the power to hear. If
there is an appeal from small-claims court, or if a Dispute changes so that the small-claims court no longer has
the ability to govern the Dispute, then the Dispute will only be heard by an Arbiter. Parties may use lawful self-
help remedies including set-off. Parties may seek remedies which don’t claim money damages, like injunctions
or equitable relief.
Either party can email or mail the other a request to arbitrate, even if a lawsuit has been filed. The notice should
describe the Dispute and relief sought. The receiving party must mail a response within 21 days. If you mail the
demand, you may choose the arbitration group. Or, your demand may state that you want the parties to choose a
local Arbiter. If related third parties or we mail the demand, you must respond in 21 days. Your response must
choose an arbitration group or propose a local Arbiter. If it doesn’t, we may choose the group.
You may select the American Arbitration Association (“AAA”) (1-800-778-7879) [Link] or JAMS
(1-800-352-5267) [Link] The parties may also agree in writing to select an arbiter from a list
of Arbiters, a former retired judge, or attorney from the area. The Arbiter must arbitrate under AAA or JAMS
consumer rules. The rules can be obtained from the Artiber Association. Any rules that conflict with any of our
agreements with you, don’t apply. If the parties are unable to decide on an Arbiter and the Arbitration
Association is not able to select a mutually agreed Arbiter then a court may choose the Arbiter.
The Arbiter will select the location of the hearing and will typically try to use a location within a reasonable
proximity of your home or where the transaction occurred.
The Arbiter’s decision will be final. A party may file the Arbiter’s award with the proper court. Arbitration will
resolve appeals of a small-claims court judgment. A party may appeal under the FAA. If the amount in
controversy exceeds $10,000.00, a party may appeal the Arbiter’s finding. Such appeal will be to a three-Arbiter
panel from the same arbitration group. The appeal will be de novo, and resolved by majority vote. The appealing
party bears appeal costs, despite the outcome.
If you request, the Lender will advance your “Arbitration Fees”. This may includes filing, administrative,
hearing, and Arbiter’s fees. You will be responsible for your own attorney fees and other expenses involved with
the Arbitration. The Arbiter may award the same damages as a court. Arbiters may award reasonable attorney
fees, and expenses, if allowed by law. If the Arbiter awards in your favor, you don’t reimburse the other parties
the Arbitration Fees, but if if the Arbiter doesn’t award your favor, then you must repay the Arbitration Fees but
this amount should not exceed state court filing fees. You can request an explanation of the award from the
Arbiter by timely sending notice to the Arbiter.
You can obtain a loan and credit services and not be required to arbitrate if you: i) resolved the matter informally
by contacting us and attempting to work it out first, ii) filing the matter in small claims court within the state
jurisdictional limits, or iii) Timely Opt-Out as set forth below.
BORROWER SIGNATURE: Borrower’s signature below indicates Borrower’s confirmation that Borrower
has read and agrees to the terms, conditions, and acknowledgements noted above on this Agreement.
Under the Federal E-Sign Act (E-Signature Act) the typing of your name along with your IP address and time
stamp is the same as you physically signing this document in person. Further you have previously consented to
the use of e-signatures and electronic communications.
You, MATTHEW HEIRONIMUS, authorize Galt Financial Solutions, LLC, hereinafter called Company, its
agent, successor or assigns to initiate preauthorized debit entries or automated Clearing House (“ACH”) entries
including but not limited to debit entries, Debit Card entries remotely created checks, remotely created payment
orders, demand drafts, bank checks, bank drafts or similar payment device to any account that you place on file
with the Company or indicated at the designated depository financial institution below, hereinafter called
DEPOSITORY, for the scheduled payment amounts as listed in the Payment Schedule below or in accordance
with your obligations under the Installment Loan Agreement and Disclosures (“Loan Agreement”) which is
hereby incorporated into this authorization. You choose the convenience of having your loan payments under the
Loan Agreement made automatically from your account. You acknowledge that this Authorization is not a
condition of the loan.
DISCLOSURES:
THIS AUTHORIZATION IS VOLUNTARY AND IS NOT REQUIRED TO OBTAIN THIS LOAN I
ACKNOWLEDGE THAT THIS AUTHORIZATION IS NOT A CONDITION OF THE LOAN.
PAYMENT SCHEDULE
No. Date Amount No. Date Amount No. Date Amount
1 25 Oct 2024 $156.02 5 20 Dec 2024 $156.02 9 14 Feb 2025 $156.02
2 8 Nov 2024 $156.02 6 3 Jan 2025 $156.02 10 28 Feb 2025 $156.02
3 22 Nov 2024 $156.02 7 17 Jan 2025 $156.02 11 14 Mar 2025 $156.02
4 6 Dec 2024 $156.02 8 31 Jan 2025 $156.02 12 28 Mar 2025 $155.81
BANK ACCOUNT INFORMATION DEBIT CARD INFORMATION
Bank Name: PNC BANK, NA Type of Debit Card:
Routing Number: 071921891 Name on Debit Card: MATTHEW HEIRONIMUS
Account Number: 4753624676 Card Number:
Expiration Date:
Debit Card Billing Zip Code:63031
This authorization is to remain in full force and effect until COMPANY has received written notification from
me of its termination a reasonable time prior to the next due date of the debit authorized by this AGREEMENT.
1. You guarantee and warrant that you are the legal debit cardholder/duly authorized check signer on the
above account(s), and that you are legally authorized to enter into this Payment Authorization.
2. You agree to notify COMPANY in writing of all changes to my account(s), including termination of
authority in reasonable time prior to the next due date of the debit authorized by this form.
3. For notification purposes, all notices of termination or account changes must be sent as certified mail to
Company at 539 W. Commerce st #6510, Dallas, Texas 75208.
4. You acknowledge that you have entered into a Loan Agreement as of today's date. You hereby authorize
the COMPANY to withdraw any amounts due as set forth in the Loan Agreement due from your account.
If you Default on your Loan or there is a balance due after the scheduled final due date of the Loan, you
authorize the Company to continue to debit your Accounts until the unpaid balances is paid in full. While
you are authorizing the Company to debit your account, Company is under no obligation to due so.
The COMPANY is informing me of the right to receive notice of all varying transaction amounts. However the
COMPANY is giving me the option of receiving notices only when a transaction falls outside of the range of
amounts listed in the above Payment Schedule box or paragraph 5 above. Therefore, you agree to one of the
following:
[$to||nvt] You hereby agree that you want to receive notice of varying transfers.
[$to||limitedNvt] You hereby agree that you want to receive notice of varying transfers only when the amount of
the transfer falls outside the range of amounts specified on this form.
You understand that I have the right to revoke this agreement at any time by sending a written notice to the
COMPANY.
PLEASE NOTE THAT YOU ARE NOT REQUIRED TO AGREE TO THIS AUTHORIZATION IN ORDER
TO OBTAIN A LOAN FROM US. IF YOU WISH TO DISCUSS OTHER PAYMENT METHODS THAT
ARE AVAILABLE DO NOT CLICK THE "I AGREE" BUTTON BELOW AND GIVE US A CALL AT 888-
743-6229. This Payment Authorization is for your convenience. By clicking the "I AGREE" button below you
agree to payment via this Payment Authorization you acknowledge that you are voluntarily choosing to pay
electronically, that you have received a copy of the Payment Authorization, and that you are choosing only to
receive notice of varying amounts of debits only when a debit exceeds the range specified above. You also
authorize us to verify all of the information that you have provided on your application or to us otherwise. If
there is any missing or erroneous information in or with the information that you have provided to us in the Loan
application regarding your bank, bank routing and transit number, or account number, then you authorize us to
verify and correct such information. You agree that this Payment Authorization is subject to the approval of the
Loan Agreement.
Under the Federal E-Sign Act (E-Signature Act) the typing of your name along with your IP address and time
stamp is the same as you physically signing this document in person. Further you have previously consented to
the use of e-signatures and electronic communications.
Authorization. You hereby voluntarily authorize Galt Financial Solutions, LLC our agents, successors or
assigns, to initiate preauthorized Debit Card transactions, for debit entries to your bank account or debit card
("Your Account") in accordance with the payment schedule below and in accordance with your obligations
under your Installment Loan Agreement and Disclosures (the "Loan Agreement"), which is hereby incorporated
into this Authorization. All terms herein shall have the same meaning as in your Loan Agreement. This
authorization is referred to as your "Debit Card Authorization." You acknowledge this Debit Card Authorization
is being signed in accordance with the Electronic Signatures in Global and National Commerce Act (ESign) and
that you have received notice of Electronic Disclosures as part of your Loan Agreement.
PAYMENT SCHEDULE
No. Date Amount No. Date Amount No. Date Amount
1 25 Oct 2024 $156.02 5 20 Dec 2024 $156.02 9 14 Feb 2025 $156.02
2 8 Nov 2024 $156.02 6 3 Jan 2025 $156.02 10 28 Feb 2025 $156.02
3 22 Nov 2024 $156.02 7 17 Jan 2025 $156.02 11 14 Mar 2025 $156.02
4 6 Dec 2024 $156.02 8 31 Jan 2025 $156.02 12 28 Mar 2025 $155.81
1. If application for credit is approved and the Loan Agreement is signed and accepted, resulting in a loan
(“Loan”) to you, we will use commercially reasonable efforts to deposit the loan proceeds into Your
Account on 2024-10-08 ("Disbursement Date")? however, unavoidable delays may result due to internet
connectivity, inadvertent processing errors and/or "acts of God" which may extend the time for the
deposit. You authorize us to initiate debit entries on the Payment Dates set forth above as well as any
deferred, extended or default payment dates, and to re-initiate the debit entries up to two times per debit to
the extent permitted by applicable state and federal law, in accordance with the payment schedule below
and the terms of your Loan Agreement. If any Payment Date falls on a Saturday, Sunday or bank holiday,
your payment will be deducted on the next business day. Please note that you have the right to receive
notice of all electronic funds transfers from Your Account that vary in amount from the payment schedule,
and that by signing this Debit Card Authorization, you acknowledge that we have elected to offer you a
range of amounts for debit entries (instead of providing you with notice of each electronic funds transfer
that varies in amount). The range of each debit will be between the Payment Amount as listed above, plus
any insufficient funds fee ($25.00). For any amount outside of this specified range, we will send you a
notice before initiating such debit. In the event of an overpayment, we will promptly refund any such
overpayment to Your Account.
2. If you make a payment of the full amount due of any installment or your entire Loan balance no less than
three (3) business days before the scheduled Payment Date, we will use commercially reasonable efforts to
stop the automatic debit for that period. You may pay off your Loan at any time and there is no
prepayment penalty. Partial prepayments made in accordance with the terms of your Loan Agreement
shall be applied to reduce principal on the date received.
3. If any debit is returned unpaid, in accordance with the terms of your Loan Agreement, you authorize us to
make an electronic funds transfer/debit entry from Your Account to collect an insufficient funds fee of
$25.00. Any improperly charged NSF fee will be returned to you.
PLEASE NOTE THAT YOU ARE NOT REQUIRED TO AGREE TO THIS DEBIT CARD
AUTHORIZATION IN ORDER TO OBTAIN A LOAN FROM US. IF YOU WISH TO DISCUSS OTHER
PAYMENT METHODS THAT ARE AVAILABLE DO NOT CLICK THE "I AGREE" BUTTON BELOW
AND GIVE US A CALL AT 888-743-6229.
This Debit Card Authorization is for your convenience. By (e)signing below you agree to payment via this Debit
Card Authorization, you acknowledge that you are voluntarily choosing to pay electronically, that you have
received a copy of this Agreement, and that you are choosing only to receive notice of varying amounts of debits
only when a debit exceeds the range specified above. You also authorize us to verify all of the information that
you have provided on your application or to us otherwise. If there is any missing or erroneous information in or
with the information that you have provided to us in the Loan application regarding your bank, bank routing and
transit number, or account number, then you authorize us to verify and correct such information. You agree that
this Debit Card Authorization is subject to the approval of the Loan Agreement.
Under the Federal E-Sign Act (E-Signature Act) the typing of your name along with your IP address and time
stamp is the same as you physically signing this document in person. Further you have previously consented to
the use of e-signatures and electronic communications.
In the event of default or your failure to make a payment, You, MATTHEW HEIRONIMUS, authorize Galt
Financial Solutions, LLC, hereinafter called Company, its agent, successor or assigns to initiate one or more
debit entries or automated Clearing House (“ACH”) entries including but not limited to ACH entries, debit
entries, Debit Card entries remotely created checks, remotely created payment orders, demand drafts, bank
checks, bank drafts or similar payment device to any account that you place on file with the Company or
indicated at the designated depository financial institution below, hereinafter called DEPOSITORY, on future
dates on which you will receive regular income for that amount that, when combined, will not exceed the total
amount owed under your Consumer Installment Loan Agreement and Disclosures(“Loan Agreement”), which is
hereby incorporated into this authorization.
DISCLOSURES:
THIS AUTHORIZATION IS VOLUNTARY AND IS NOT REQUIRED TO OBTAIN THIS LOAN I
ACKNOWLEDGE THAT THIS AUTHORIZATION IS NOT A CONDITION OF THE LOAN. You may
revoke this authorization by providing us notice in writing to 539 W. Commerce st #6510, Dallas, Texas 75208
or support@[Link]. You understand that it may take up to three (3) business days to process your request
for revocation.
All applicants must "check" one of the following scenarios, in order to proceed with application.
10 / 07 / 2024
APPLICANT'S NAME: MATTHEW HEIRONIMUS DATE: [date|req|signer0]
Federal law provides important protections to active duty members of the Armed Forces and their dependents.
To ensure that these protections are provided to eligible applicants, we require you to sign one of the following
statements as applicable:
I AM a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast
[$im||imy] Guard, serving on active duty under a call or order that does not specify a period of 30 days or
fewer.
I AM a dependent of a member of the Armed Forces on active duty as described above,
because I am the member's spouse, the member's child under the age of eighteen years old, or I
[$im||imo]
am an individual for whom the member provided more than one-half of my financial support
for 180 days immediately preceding today's date.
I AM NOT a regular or reserve member of the Army, Navy, Marine Corps, Air Force or Coast
[$im||imn] Guard, serving on active duty under a call or order that does not specify a period of 30 days or
fewer (or a dependent of such a member).