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Authorization for Automatic Loan Payments
Please fill out form and mail to address below.
Mail to:
Metro Credit Union
Att: Consumer Lending, 200 Revere Beach Parkway P.O. Box 9100, Chelsea, MA 02150-9100
New Change Stop
Member Name(s):
I/we authorize Metro Credit Union to deduct my/our loan payment on an automatic basis from the
account listed below:
Account Number:
Suffix:
Account Owner (If Different):
Payment Amount: $
Frequency:
Weekly
Bi-weekly
Monthly
Semi-monthly
Transfer Instructions:
Until Further Notice
Months until
(Specific Date) OR
For
I/we acknowledge that while payments are on automatic transfer, I/we will not receive a notice for
payment; however, the loan information will appear on my/our primary account statement. I/we further
acknowledge that if I/we make a payment independently, the automatic payment will still be deducted from
the account as instructed.
Borrower Signature Date Co-Borrower Signature Date
3/15
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signature
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