ACH Origination for Loan Payment – Form …

ACH Origination for loan Payment form Instructions Complete the form , print and send it back to USECU with a voided check. Upon receipt of the form , we will complete a Call Back Verification prior to initiating the ACH Origination . Documents can be returned to USECU by: Fax: 858-795-6034 Mail to: USE Credit Union Attn: Member Service Center 10120 Pacific Heights Blvd Suite 100 San Diego, CA 92121 Bring documents to one of our USECU branches. 10120 Pacific Heights Blvd., Ste. 100, San Diego, CA 92121 Phone: ACH Origination authorization agreement USECU loan Payment I hereby request and authorize USE Credit Union ( USECU ) to initiate, change or cancel, as applicable, debit entries from my account at the Depository Institution to be credited to the identified USECU loan as described below. New Request Change/Update CancelFROM: Depository Institution Name Phone Number Routing Number (must be 9 digits) Savings Checking (please attach a voided check) Account Number TO: USE Credit Union Membership Number loan ID Start Date Amount $ Frequency Monthly Semi-Monthly* Weekly on Friday *For semi-monthly select two days (not 29, 30 or 31): _____ and _____By signing below I confirm I have the authority to authorize debits from the Depository Institution described herein and I understand and agree to the following terms and conditions.

10120 Pacific Heights Blvd., Ste. 100, San Diego, CA 92121 Phone:866.USE.4.YOU . ACH Origination Authorization Agreement USECU Loan Payment. I hereby request and authorize USE Credit Union (“USECU”) to initiate, change or cancel, asableapplic, debit …

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