ACH Authorization Agreement

Legal Community Credit Union Account Information

Member Name
Credit Union Account Number
Account Type:
Checking
Savings
Loan

Request Type

New
Update
Cancellation

Financial Institution Information

Name on Account
Financial Institution Name
Routing Number

City

State

Account Number

Account Type:
Checking
Savings
Loan

Periodic Transfers
Amount
Deposit to Credit Union
Frequency:
Weekly
Bi-Weekly
Monthly

Start Date

Withdrawal from Credit Union

ACH on Demand per transaction fee applies

I authorize LCCU to transfer funds on request as directed either by phone or email
Permissible Transactions:
Deposit to Credit Union
Withdrawal from Credit Union

Certification
I hereby authorize Legal Community Credit Union (LCCU) to initiate either a credit or debit entry to my account as indicated above. I
acknowledge that the origination of ACH transactions to my account must comply with the provisions of US law. If the transaction
date of any scheduled payment is not on a business day, the activity will occur on the next business day. I understand that any
authorized transfer returned to LCCU will cause a non-sufficient funds charge to my account. If my loan payment increases or
decreases during this authorization I understand that LCCU will automatically adjust my payment amount. This authorization is to
remain in full force and effect until LCCU has received written notification from me of its termination in such time and manner as to
afford LCCU a reasonable time to act on it. This authorization may be unilaterally terminated by LCCU in cases of excessive returns
or member abuse. Once and account is closed or a loan is paid off, it is the responsibility of the member to cancel the ACH
transaction. The cancellation must be received at least five business days prior to the date it is scheduled to pull.

Signature_________________________________

Date_____________________________