Star One Credit Union
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Star One Recurring Authorization Agreement for Electronic Payment

Member Name Member Number
Telephone No.

General Information
This is a new authorization. Effective Date:
Change an existing authorization. Effective Date:
Cancel an existing authorization. Effective Date:

Transfer Type (Select One)
Transfer to Star One CU Loan No. (excluding Visa, HELOC & Personal LOC) from my personal account at another financial institution.
Transfer to Star One CU Savings OR Checking from my personal account at another financial institution.
Transfer from Star One CU Savings OR Checking to my personal account at another financial institution.

Transfer Information
Transfer Frequency Monthly       Bi-Weekly       Weekly
Day/Date of Transfer Transfer Amount

Other Financial Institution Information
Name on the Account
Financial Institution Name
ABA/Routing Number Account Number
Account Type Savings       Checking

I authorize Star One Credit Union to originate Electronic Funds Transfer transactions between the Credit Union and the other Financial Institution indicated above. This authorization is to remain in full force and effect until the CREDIT UNION receives my WRITTEN NOTIFICATION of its termination at least (3) three business days before the scheduled date of transfer in order to be effective. This authorization must be provided to the Credit Union at least 10 days before a new or existing payment takes place. A $13.00 fee will be charged to the above Credit Union savings or checking account for each item returned. The Credit Union may terminate this agreement if the Credit Union receives (3) NSF's for the same account number or otherwise if I fail to comply with my Membership and Account Agreement. A one time set up fee of $5.00 will be charged for each new request.

I further acknowledge that any electronic fund transfers initiated will not violate provisions of U.S. Law, including the requirements of the Office of Foreign Asset Control (OFAC). Some restrictions apply; all requests are subject to approval.

Please note that when your scheduled payment/transfer date falls on a weekend or non-business day, your payment/transfer will occur on the business day prior to your actual transfer date.

Please sign, date, print, and mail this form to PO Box 3643 Sunnyvale, CA 94088 or fax it to 408-543-5203 Attn: Support Services

Member Signature: _______________________________Date: ________________

For Credit Union Use Only
Form Received by: (Initial & Teller#)   Date:  
Processed by: (Initial & Teller#)   Date:  
Verified by: (Initial & Teller#)   Date:  

 

REV: 03/17/2014

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