Internal Automatic Transfer

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Change
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Member Information

Member Name

First Last

Account Number*

Address

Street Address City State / Province / Region ZIP / Postal Code

Email*

Primary Phone*

Secondary Phone

Transfer Information

Transfer Type*

Automatic Transfer
Payroll Deduction

If you want to transfer funds out of your account, choose Automatic Transfer. If you want the transfer to occur every time a Direct Deposit is made, choose Payroll Deduction.

if Payroll Deduction, please enter Deposit Source:

Name on Account to transfer to:

First Last

Account Number*

Suffix*

Account Type

Savings
Checking
Loan

Amount*

Start Date

Withdrawal Frequency*

Monthly
Semi-Monthly
Bi-Weekly
Weekly

Comments

Transfer Authorization

Member Signature

By signing above, I understand it is my responsibility to maintain a balance in my account or a direct deposit, to enable the transfer/payroll deduction to be processed. If there are not sufficient funds in the account on the transfer date, available funds will be used to make a partial transfer in any order determined by LCU. The transfers will continue until I notify LCU in writing to cancel or update the transfer or if the Credit Union notifies me the transfer will be discontinued.

Date

Revocation

Please sign below if you wish to cancel this transfer.

Member Signature

Date