A DIVISION OF Gesa CREDIT UNION
■
□
■
■
□
□
■
□
□
□
□
■
■
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□----
□
□
□
Use this form to TRANSFER FUNDS from
another financial institution to your credit
union savings, checking, or loan account.
ACH DIRECT TRANSFER AUTHORIZATION
Authorization to Withdraw Funds from another Financial Institution
When you take advantage of automated transfers, you save time and reduce the risk of a missed payment or transfer.
Use automated transfers to: • qualify for a discount on most loans
• make loan payments
• build your savings or checking balance.
Name
1
2
3
I’d like to: begin a new direct transfer update my existing direct transfer cancel my direct transfer
This request should take effect starting (month, day, year)
The withdrawal will come from
(name of financial institution)
Checking: a voided check from the other financial institution must be attached.
OR
Savings, account number 9-digit routing number
4 Deposit the funds to my Inspirus Credit Union account, number as instructed below.
Quarterly on this date: Semimonthly on these two dates:
Deposit to Savings/Checking, sub #
Monthly on this date:
Transfer amount: $
Biweekly
( M T W TH F ) on this day:
Weekly
( M T W TH F ) on this day:
Monthly on this date:
Semimonthly on these two dates:
Payment to Loan #
Transfer amount: $
Biweekly
( M T W TH F ) on this day:
Weekly
( M T W TH F ) on this day:
Quarterly on this date:
Semimonthly on these two dates:
Deposit to Savings/Checking, sub #
Monthly on this date:
Transfer amount: $
Biweekly
( M T W TH F ) on this day:
Weekly
( M T W TH F ) on this day:
Monthly on this date:
Semimonthly on these two dates:
Payment to Loan #
Transfer amount: $
Biweekly
( M T W TH F ) on this day:
Weekly
( M T W TH F ) on this day:
Please note: Transfers to loans are stopped automatically when a loan has beenpaid in full.
Additional transfers (optional)
I hereby authorize Inspirus Credit Union, a division of Gesa Credit Union (the credit union), to withdraw funds, and make corrections if necessary, for the transfers to my account(s) indicated above.
If the funds are unavailable, it will be my responsibility to arrange payment. If the funds are unavailable for three (3) consecutive transfers, the credit union may cancel the above agreement. When the transaction
date falls on a weekend or holiday, the transaction will be made the following business day. My monthly statement will serve as my receipt.
This authorization will remain in full force and effect until a loan is paid in full or until the credit union has received a written cancellation request from me in such time and manner as to afford the credit union and
the other financial institution a reasonable opportunity to act on it.
)
Signature Daytime Phone
(
Date
6
After filling out this form, return it to: Inspirus Credit Union, P.O. Box 576, Seattle, WA, 98111-0576 OR via fax at (206) 676-3690
OR submit the form electronically via Digital Banking. Just select the Message Center widget, click on the “Compose” button and
attach the file. Please allow five business days for processing of your request.
13437.001 02/2019
5
click to sign
signature
click to edit
![]()
