WNY FCU Electronic Loan Payment

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First Name*

Last Name*

Email*

WNY FCU Member Number*

Control Number

Account Number

WNY FCU Loan Number*

WITHDRAWAL OF FUNDS FROM THE FOLLOWING FINANCIAL INSTITUTION

Account Type for Withdrawal*

Checking Account

Savings Account

Routing Number*

Account Number*

Withdrawal Amount* (Daily maximum of $2,000)

Withdrawal Date* Any submission made before 3PM, will be processed on the next business day. Submissions after 3PM, will be processed on the 2nd business day. This is NOT a same day service.

Withdrawal Type*

One Time

Recurring

I understand that this authorization will remain in effect until I cancel it in writing and I agree to notify WNYFCU in writing of any changes in my account information or termination of this authorization at least 10 days prior to the next billing date.

If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment will be executed on the next business day.

I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above-noted periodic transaction dates. I agree to an additional $25.00 charge for each attempt returned NSF, which will be initiated as a separate transaction from the authorized recurring payment.

I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.

I agree to the above