Direct Payment
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1DIRECT PAYMENT
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ACH Credit/Deposit to IBM Southeast EFCU from another financial institution.
Authorization Agreement for Electronic Fund Transfer
Use of this form:
- To credit/deposit funds into your IBM Southeast EFCU account from another financial institution.
- The credit/deposit cannot exceed $5,000; higher amounts must be processed as incoming wire transfers.
Remember:
- Cancellations or changes to this agreement must be in writing and require 5 days advance notice.
- For verification, a voided check or deposit slip from the other institution must be attached to this completed form.
- You can use this form for monthly, weekly or “one time only” transactions.
- Delivering a signed copy to the Credit Union in person, by mail or fax authorizes Direct Payments.
I hereby authorize IBM Southeast Employees’ Federal Credit Union to initiate debit entries to my account at
the financial institution listed below. I acknowledge that the origination of ACH transactions to my account
must comply with the provisions of U.S. Law.
Financial Institution:__________________________________ Branch:___________________________
City:________________________________________________ State:________ Zip Code: ___________
Routing Number:____________________________ Account Number: ___________________________
Type of Account
: __________ Checking _________ Money Market _________ Savings
(Please check one)
Please attach a voided check or deposit slip from the other financial institution to this signed agreement.
Amount to Debit $: ____________________________ Date to Debit: _____________________________
Recurrence
: ___________ Monthly ___________ Weekly ___________ One Time Only
(Please check one)
Action
: ___________ Start ___________ Skip ___________ Change ___________ Stop
(Please check one)
Distribute funds to IBM Southeast EFCU account #: _________________________________________
This authorization is to remain in full force and effect until IBM Southeast Employees’ Federal Credit
Union has received written notification from me of its termination, in such time and in such manner
as to afford IBM Southeast Employees’ Federal Credit Union a reasonable opportunity to act on it.
-
Direct Payments scheduled on weekends or holidays will take place on the next business day. The Credit Union will not be liable for
any fees or charges assessed by other financial institutions.
-
The information supplied on this agreement must be accurate and current. You will be liable for any losses incurred as a result of
incorrect information. Immediately notify the Credit Union in writing of any changes involving account number, frequency or amount.
-
In the event funds are unavailable at the other financial institution, the Credit Union will not re-initiate the debit entry until the next
scheduled transfer. It is your responsibility to make other arrangements to pay any loan that was not performed for that transfer
frequency. The Credit Union is not obligated to furnish you with a notice in the event the transfer was not completed, nor is the Credit
Union liable for any fees or charges assessed by other financial institutions.
Member Name: ____________________________________ Member Number: _____________________
Member Signature: __________________________________________ Date: ______________________
Daytime Phone #: _____________________________ E-mail Address: ___________________________
Please send this completed form via fax to Electronic Processing at (561) 982-4776, or by mail to
IBM Southeast EFCU, P. O. Box 5090, Boca Raton, FL 33431-0890.
For assistance, please call (800) 873-5100 or (561) 982-4700 or e-mail .
Operator Name and Number: ____________________________ Extension: _______________________
Date and Time Received: ___________ Processed By Operator Name and Number: _______________
IBM Southeast EFCU – Direct Payment / ACH Origination (R7/04)
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