Ach Debit Authorization Agreement – Fill Out and Use This PDF

ACH DEBIT AUTHORIZATION AGREEMENT

Use this form to request recurring transfer of funds from your account at another financial institution to your BECU account. Complete this form only if the other institution cannot set up the transfer.

Indicate the reason for this Debit request (check only one):

☐Create a new ACH authorization (Complete sections 1-4 and 6.)

☐Change the date/amount/bank/account number of an existing ACH authorization (Complete sections 1-4 that apply, and 6.)

☐Cancel an existing ACH authorization (Complete sections 5 and 6.)

1. Account Information

2. Financial Institution to Debit

To avoid processing delays:

Requests must be received by BECU 10 business days prior to date of the debit.

You must be an account owner on both accounts.

Attach document from the other financial institution:

Must be pre-printed with the names of the account owners and the complete account number.

Acceptable documentation: voided check, statement copy, or verification letter.

3.Amount to Debit

AMOUNT TO DEBIT (Not to exceed $5,000 per month)

4. Date / Frequency

Note: If the date you have requested the ACH transaction to occur is on a weekend or holiday, the transaction will occur the following business day. If you are using the funds for a BECU loan payment, you must choose a date 4 days prior to your loan due date to avoid NSF fees.

5. Cancel an Existing ACH Debit Authorization

6. Authorization

I (We) acknowledge that the origination of ACH transaction to my (our) account must comply with the provision of U.S. Law and the Rules of the National Automated Clearing House Association. I (We) further acknowledge that I (we) have retained a copy of this authorization when I (we) signed it.

You hereby authorize and request BECU to debit funds from your account at the financial institution indicated, and credit the funds according to the above instructions. Funds need to be on deposit at the designated financial institution on the evening prior to the effective date of the ACH debit. In the event of an error, you authorize BECU to take any and all action required to correct the error.

We may cancel and or terminate any EFT services at any time for any reason and without prior notice, but we may notify you after the cancelation or termination as may be required by law.

If you are using funds for a BECU loan payment, the ACH may automatically inactivate once the loan is paid off. Please notify BECU if you would like the authorization to continue. You must notify BECU in writing if you would like to make any changes or to cancel the authorization.

You agree to indemnify and hold BECU harmless from all costs, including attorney’s fees, (to the extent permitted by law), damage or claims related to BECU’s action in refusing payment of the item, including claims of any joint account -holder, payee, or endorsee, or in failing to cancel or process an item as a result of incorrect information provided by you.

By signing below, you certify that the information you have given on this ACH Debit Authorization Agreement for Direct Paymen ts is complete, true, and submitted for the purpose selected above.

BECU Use Only

If form is not submitted electronically, please return completed and signed form to:

BECU 7985 01/2020