Authorization Agreement For Ach Debit Origination - Tennessee Credit Union

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Authorization Agreement for ACH Debit Origination
As a duly authorized signer on the financial institution account identified below, I hereby
authorize The Tennessee Credit Union to initiate debit (withdrawal) entries and to initiate, if
necessary, credit entries and adjustments for any debit entries in error from my (check one)
________ checking ________ savings account indicated below in the amount of $_______
(Loan payment amount may be subject to change). This debit is to take place on the _________
of each month or the next business day if the date requested should fall on a weekend or holiday.
Bank Name ___________________________________________________________________
City ______________________________ State ______________________ Zip ____________
Routing Transit No. ___________________ Account No. ______________________________
This authority is to remain in effect until The Tennessee Credit Union has received
written notification from me to its termination in such time and in such manner as to afford a
reasonable opportunity to act on it. I understand that any payment received after my loan is paid
in full will be deposited into my TTCU share account and will not be immediately available for
withdrawal.
There is a $500 daily limit on debit originations transferring to a TTCU savings or checking
account. The current fee will be assessed for items returned for nonpayment. The Tennessee
Credit Union reserves the right to revoke this agreement at any time if abuse of this agreement
becomes evident or is suspected.
Name ________________________________________________________________________
The Tennessee Credit Union Account No. _______________________________________
Signature of authorized signer* ___________________________________Date _____________
*Signature must be notarized if account being credited is not owned by person authorizing debit.
Please attach a voided check or a statement with savings account information for the
account from which the debits are to be made, as we no longer accept deposit slips.
Origination of Loan Payments
I expressly authorize the Credit Union to discontinue the debit from my other financial institution
for my TTCU loan payment upon payoff of the loan or to request change in financial institution
information.
Signature of authorized signer* _________________________________Date _____________
*
Signature must be notarized if account being credited is not owned by person authorizing debit.
---------------------------------------------------------------------------------------------------------------------
For Employee Use Only
Member Name ____________________ S.S.N./Acct#: ___________________ ACH Start Date: _______________
Distribute to Account (s) as follows:
$ _____________ Regular Share Account
$ ___________ Christmas Club
$ _____________ Share Draft Account
$ ___________ Other Account __________
$ _____________ IRA Account
$ ___________ Other Account __________
PRD Department: Start Date: ________________ Employee: __________________
ACHDebitAuth09/15

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