Your Name (required)

Your Phone number (required)

Your email address (required)

Name of HOA (not Bristol South) (required)

Property address (required)

If Paying for a 6d Certificate, Choose One:
N/A$100 - more than 2 weeks (10 business days) to closing$150 - Closing is less than 2 weeks/ 10 business days$200 - 3 business days or less to closing
If Paying for a Questionnaire, Choose One:
N/A$100 - Fannie Mae Form 1077 / Short Form$150 - Fannie Mae Form 1076 / Full Form$200 - Bank preferred$250 - Single Unit FHA approval questionnaire$500 - FHA Approval questionnaire for Whole Association
Choose Your Payment type:
—Please choose an option—Checking account - $3.95 processing feeSavings account - $3.95 processing feeDebit Card - 6.95%Credit Card -7.95% processing fee
COMPLETE APPROPRIATE SECTION BELOW
----CREDIT CARD OR DEBIT CARD----
Card Number

Expiration Date
—Please choose an option—01- January02- February03 - March04 - April05 - May06 - June07 - July08 - August09 - September10 - October11 - November12 - December
Expiration Year

CVV2 (security Number)

First Name

Last Name

Billing Address

Billing City

Billing State

Billing Zip Code

----CHECKING OR SAVINGS ACCOUNT----
Name on Account

Bank Name:

Routing number:

Account number:

I Authorize Bristol South, Inc to process this payment