Recurring Authorization Agreement

Form Instructions

Your Information

Member Name:
Member Number:
Telephone Number:

General Information

	This is a new authorization.
	Change an existing authorization.
	Cancel an existing authorization.

Effective Date:

Transfer Type

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

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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.

___________________________________________ Member Signature

_______________________ Date

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Rev: 09/19/2014