Automa c Payment Authoriza on Form
Use this form to schedule recurring a recurring monthly transfer from your USPS FCU account or your
account at another financial ins tu on to your loan at U. S. Postal Service FCU.
If you are establishing a recurring monthly transfer from another financial ins tu on a ach a voided
check from your other financial ins tu on when you return this form.
Your Name:
Day me Telephone Number: Extension:
Cell Number: Email:
Apply the transfer to my USPSFCU Account Number _____________________ Loan Suffix Number _______
(Note: Automa c payments to a USPS FCU line‐of‐credit cannot be paid from another financial ins tu on.)
Select a day of the month for the monthly withdrawal. (Example: 1st, 10th, 15th day) ____________ day
Date of first withdrawal (mm/dd/yy) ______/______/____________ Amount: $______________________
WITHDRAW PAYMENT FUNDS FROM (choose one):
USPS FCU Account _________________________ Savings Checking
OR
Another Financial Ins tu on: __________________________________________________________
Ins tu on Address:
Ins tu on Telephone Number:
Name as it appears on this account:
ABA Rou ng Number* ___ ___ ___ ___ ___ ___ ___ ___ ___
* The ABA Rou ng Number is the first nine (9) digits listed at the bo om of your check. Please a ach a
voided check to this form so we may verify the ABA Rou ng Number.
Account Number __________________________ Savings Checking
I authorize U. S. Postal Service FCU to regularly withdraw funds from my account at the financial ins ‐
tu on indicated above to be applied to my loan at U. S. Postal Service FCU indicated above. I under‐
stand that if the scheduled withdrawal date falls on a weekend or holiday the withdrawal will be
made on the last business day prior to the weekend or holiday.
I understand that this process will con nue un l the Credit Union has received wri en no fica on
from me to cancel this transac on. Changes or termina on must be in wri ng and delivered to the
Credit Union no later than three (3) business days prior to the next withdrawal date. The Credit Union
has the right to make appropriate adjustments to my Credit Union account indicated above and has
the right to revoke this agreement at any me.
Signature: ____________________________________ Date (mm/dd/yyyy): _____/_____/_________
Date Received: ________________________________________________
By: _____________________________________________________________________
Please forward to Accoun ng/ACH.
Revised July 2014