AUTHORIZATION FOR RECURRING TRANSFER
Retail and Business Credit Card - RCC, SCC & BCC
Payment To:
I (we) hereby authorize M&T Bank, as lender, to obtain payment of monies owing to my (our) Credit Card Account,
Account Number ___________________, by transferring funds automatically, via ACH or other means, from my
(our) deposit account, as directed below, until further notice. Beginning _______________, and every month thereafter,
M&T Bank is authorized to transfer, in the amount of my
(Check One) □ Minimum Monthly Payment or □ Last Statement Balance
From:
Type of Account ( Check One) □ Checking or □ Savings*
Routing Number ____________________
Account Title _______________________
Account Number ________________________________
Financial Institution Name _________________________
Agreement:
I (we) agree to be bound by all of M&T Bank’s procedures governing funds transfers as in effect from time to time and applicable law
including, if applicable, Uniform Commercial Code Article 4A. I (we) understand that M&T Bank is entitled to rely on the account
number provided above without reference to account numbers and account names. Payments to my (our) Credit Card Account will
appear on my (our) monthly Credit Card Account activity statement. I (we) understand that payments will be debited from my (our)
checking/savings account on the due date of my (our) Credit Card Account and if the balance available for withdrawal from my (our)
checking/savings account is not enough to cover the Credit Card Account payment, or if the debit entry to my (our) checking/savings
account is returned, rejected, or reversed because of insufficient available funds or for any other reason, I (we) will still owe the Credit
Card Account payment. M&T Bank may, at its option, treat this as basis to demand on my (our) Credit Card Account or, if applicable,
treat this as an event of default under my (our) Credit Card Account agreement and exercise any of its remedies under that
agreement. In addition, If my (our) checking/savings account has insufficient funds to pay the debit entry for my (our) Credit Card
Account payment, M&T will be entitled to charge my (our) checking/savings account the maximum fee permitted by law that may be
charged in connection with written orders drawn on insufficient funds, or if there is no maximum fee prescribed by law, such other fee
as M&T Bank may charge its customers for transactions of a like nature.
M&T Bank can cancel this service at any time by notifying me (us) it is doing so. Otherwise, this service will continue without any further
notice to me (us) until I (we) cancel it in writing and M&T has had a reasonable time to act on my (our) cancellation prior to charging
my (our) checking/savings account. I (we) understand that I (we) do not have to sign this authorization in order to obtain a Credit Card
Account.
*There may be limits to the number of transfers that can be made from savings accounts during any monthly period. Please refer to
the terms applicable to such accounts for more information.
Customer Signature ___________________________________________ Date ___________________
Customer Signature ___________________________________________ Date ___________________
Mail this form to: Card
Services, NY1-CD20, M&T Bank, 626 Commerce Dr. Amherst, NY 14228
You may also submit the form at your local branch. For assistance with this Authorization, please call: 1-866-279-0888
Please retain a copy of this form for your own records.
REVOCATION OF AUTHORIZATION
Effective _______________, I (we) revoke the above authorization. I (we) understand that payments will continue
until you have received and had a reasonable time to act on this revocation.
Customer Signature ___________________________________________ Date ___________________
Customer Signature ___________________________________________ Date ___________________
FOR OFFICE USE ONLY
Branch # ______________ Branch Name __________________________ Date ___________________
Completed By ___________________________________________ Employee # ___________________
Original – Scan with DDW Coversheet (select Card Services) Copy – Make copy of original for customer
