Recurring Authorization Agreement for Electronic Payment
Please sign, date, print, and mail this form to:
Star One Credit Union
Attn: Support Services
P.O. Box 3643
Sunnyvale CA 94088-3643
You may also fax your completed form to (408) 543-5203 Attn: Support Services
To submit this form electronically, log in and click on the "Online Forms" tab and then click on the name of the desired application or form. Some "Online Forms" are partially auto-populated for your convenience.
|This is a new authorization.|
|Change an existing authorization.|
|Cancel an existing authorization.|
|Transfer to Star One CU
|Transfer from Star One CU
|Day/Date of Transfer:|
Other Financial Institution Information
|Name on the Account:|
|Financial Institution Name:|
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 5 business days before a new or existing payment takes place. A $ 15.00 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.
|Received by (Initial and Teller#):||Date:|
|Processed by (Initial and Teller#):||Date:|
|Verified by (Initial and Teller#):||Date:|