ACH Application :: Ministry/Business Accounts :: Forms & Applications :: Online Services

Online Services:

ACH DEBIT AUTHORIZATION FORM

I (we) hereby authorize America’s Christian Credit Union to initiate debit entries from my checking/savings accounts at the financial institution listed below, and, if necessary, initiate adjustments for any transactions credited/debited in error. This authorization will remain in effect until America’s Christian Credit Union is notified by me (us) in writing to cancel it in such time as to afford America’s Christian Credit Union a reasonable opportunity to act on it.

FROM:

Name of Financial Institution

Address of Financial Institution

Routing Transit Number

Phone Number

Account Number

Checking Savings

TO:

Account Number

Savings/Checking Suffix

Amount $

Effective Date

Frequency

Loan Number $
(Loan Payments will be transferred on the loan due date.)

I (we) understand that America’s Christian Credit Union reserves the right to cancel this agreement and terminate this transfer, with or without cause, followed by a written notification to me (us). I (we) understand that the origination of an ACH transaction to or from my (our) account must comply with provisions of United States Law.

Signature: _______________________________________

Date: ____________________________

Name

Address

PLEASE ATTACH A VOIDED CHECK TO THIS FORM

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