Mailing address: 1725 I Street NW, Suite 150 Washington ...

Member Name

Mailing Address: 1725 I Street NW, Suite 150 Washington, DC 20006-2406 T 202 212 6400 F 202 683 2380

Mortgage Payment Receipt

Date

Mortgage Account Number Amount Paid

Method of Payment (check one)

o Check # _______________ enclosed o Transfer from account number_______________________________

Daytime Phone Number

Member Signature

X

Payment Type(s):

o Monthly Payment o Additional Principal Payment o Escrow Only Payment

Credit Union Use Only Accepted by:

_________________

Initials

_____________

Date

If you have questions regarding your mortgage payment, please call our Mortgage Servicing Section at (202) 212-6450.

BFLS121.0

20050316

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