To
authorize direct payment of a CCU loan from an account at another
financial institution print the following authorization agreement.
Complete and sign the form and mail it along with a voided check
to:
Campus Credit Union
1845 Fairmount Box 65
Wichita, KS 67260-0065
AUTHORIZATION
AGREEMENT FOR DIRECT PAYMENT
I
(we) hereby authorize Campus Credit Union, hereinafter called
CREDIT UNION, to initiate debit entries to my (our) CHECKING SAVINGS
account indicated below and the depository named below, hereinafter
called DEPOSITORY, to debit same to such account. I (we) acknowledge
that the origination of ACH transactions to my (our) account must
comply with the provision of U.S. law.
DEPOSITORY
NAME _______________________________________
CITY
____________ STATE ____ ZIP _______
TRANSIT/ABA
NO. _______________________
ACCT
# _______________________________
The
above account will be debited in the amount of
$_______ starting ______ day of _________ , 20__ and posted to
my credit union account # ____________________
This
authority is to remain in full force and effect until CREDIT UNION
and DEPOSITORY has received written notification from me (or either
of us) of its termination in such time and in such manner as to
afford CREDIT UNION and DEPOSITORY a reasonable opportunity to
act on it.
NAME(S)
_________________________________
DATE
____________________________________
SIGNED
__________________________________
Please
attach a deposit slip below, if applicable.
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