PDF ACH or Automatic Loan Payment
[Pages:1]ACH or Automatic Loan Payment
Schedule your loan payment to be automatically deducted from your checking or savings account.
_____________________________________ _______________________________________
Member Name: First
Last
_______________________ Day Phone
Rapid Refinance
Line of Credit/HELOC
Installment Loan #_________________
For new or changed payments involving other financial institutions, you must allow 15 days to process this request.
Request to: (select only one)
Start a new automatic loan payment.
First payment date of _____ /_____ /_____
Stop an existing automatic loan payment.
Last payment date of _____ /_____ /_____
Change amount of an existing automatic loan payment.
First date of changed payment amount _____ /_____ /_____
*To change account numbers, dates, or frequency, STOP the existing payment and complete another form to START a new payment.
Make Payments From: (select only one) Checking # ______________________________ OR
(Signature of owner of account required below)
Savings # _________________________ (Signature of owner of account required below)
Check here if this account is NOT held at UW Credit Union. Attach a voided check and complete section below.
_________________________________________________________________________________________ Name of other institution (if any)
__________________________________________________________________________________________ Name of customer at other institution (if different from above)
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-
9-Digit Routing/Transit Number
New Amount, Date and Frequency of Payments: (select only one) If Rapid Refinance:
Monthly on the___________ day of each month for......................................................................................... $ Amount Due Additional principal payment on the same day each month for.............................................................. $ _________________________
If Installment Loan or Line of Credit/HELOC: Monthly on the___________ (1-31) day of each month for.............................................................................. $ _________________________ Twice a month on the 1st and 15th days of the month for.................................................................................... $ _________________________ Every two weeks on (Mon-Fri)________________________________ for............................................. $ _________________________ Weekly on (Mon-Fri)_______________________________________ for............................................. $ _________________________
Line of Credit/HELOC Only: Monthly on the___________ day of each month for......................................................................................... $ Amount Due
I hereby authorize UW Credit Union and its successors, assigns, authorized agents or any entity servicing my loan on their behalf (hereinafter, "UWCU") to initiate debit/credit entries as described above and, if necessary, to initiate adjustments for any transactions credited or debited to my account in error. I understand that this authorization remains in full force and effect until UWCU has received written notification from me. Such notification must be received at least three business days prior to the scheduled payment date. If the notification is verbal (made in branch or by phone at 800-533-6773), UWCU requires written verification to be received within 14 days of my verbal notice (delivered in branch or mailed to 3500 University Avenue, P.O. Box 44963, Madison, WI 53744-4963). I also hereby acknowledge receipt of an exact copy of this document.
Signature Required X ______________________________________________________ Date ______ /_____ /______
Note: In order to change or cancel this authorization, UW Credit Union must receive an updated ACH or Automatic Loan Payment form. To avoid delays, please do not cancel the authorization through any other financial institution involved.
Office Use Only Transfer Record Number: _______________________
Teller Number: _________________
Original: UW Credit Union Lending Services Copy: Member Complete and sign this form and drop it off at any UW Credit Union office, fax (608-236-2985) or mail to: UW Credit Union, P.O. Box 44963, Madison, WI 53744-4963
FEDERALLY INSURED BY NCUA
DG5008 2.1 (3/19)
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