Payment Consent Authorization Letter Form

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Dear Member,
RE: Account #________________
This letter serves as confirmation of your consent to authorize TECU Credit Union to
pay one time debit card transactions (this includes point of sale and ATM
withdrawals) on the account referenced above when there are insufficient funds
available to cover the transaction.
You have a right to revoke this consent at any time. Simply complete and return this
form to us at the address listed below or contact us by phone at 316-263-5756.
Sincerely,
Member Service
TECU Credit Union will discontinue its payment of such overdrafts as soon as possible
after receiving notice of your revocation. Any joint owner of the account may revoke
the agreement.
I revoke my earlier consent for the payment of overdrafts on ATM and one-
time debit card transactions on the account identified above.
Signature ____________________________ DATE
_________________

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