P.O. Box 1268
Eureka, CA 95502
(707) 443-8662 Phone (707)
443-8664 Fax
Yes,
I would like to have my CSFECU credit card payment made automatically.
Name_________________________________________ Date____________________
(As it appears on credit card)
Credit Card account number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Please
tell us from which account you would like the payments withdrawn:
Financial
Institution Name _________________________
Account #_______________
Savings
_____ Checking _____ Routing # ___________________________
(Check one) (Call your financial institution if you don’t know.)
I
want to pay (check one):
Fixed
Amt $ ____ Minimum Pmt ____ Balance in full ____ Percent of Balance ____%
(Balances will be calculated from previous month’s statement.)
I want the payment to be made ____ (1-25) days after statement print date. (The statement print date varies, anywhere from the 16th to the 19th of the month. So, for example, if you want your payment to be made on the 5th of the month or shortly thereafter, then you would enter 20 in the space above. If the payment date falls on a Saturday or Holiday, the payment will be made the next processing date.)
There is no fee for this service; however, if your account has insufficient funds to make the payment, a $3.00 payment return fee will be charged to your account.
If
you wish to cancel, you must notify us in writing, at the address set forth
above, at any time up to 3 business days before the scheduled date of the
transfer.
This automatic payment may take up to one full statement cycle to take effect. You must mail in your payment until you receive a statement, which says, “It is not necessary to mail your payment. A debit to your checking/savings accounts for ___ $ will be initiated per your agreement with us.”
Attach VOIDED check if payment is to be made from another institution.
SIGNED______________________________ DATE ________________________
SIGNED______________________________ DATE ________________________