Authorization For ACH Origination (regularly transfer funds from one financial institution to another)

By Fax:

Complete the information requested, then print out all pages of the application and fax to our secured number: 323-505-2613

By Mail:

Complete the information requested, then print out all pages of the application and mail in a sealed envelope to Cal State L.A. Federal Credit Union Post Office: P.O. Box 1117, Montebello, CA 90640-1117

In Person:

Bring the completed application to our office at 2445 Mariondale Ave, Los Angeles and submit it confidentially to one of our specialists.

Start Change Name: CSULA-FCU Account Number:

Home Phone: Work Phone:

I hereby authorize California State University, Los Angeles Federal Credit Union to originate the following ACH transaction:

From:
Name of financial institution:          Routing Number of financial institution:  9 digits


Account Number:       Checking or Savings

Send a total of

Transfer Dates: Day(s) of the month. (ie, 10th of each month, 1st and 15th of each month, etc)

                               If the scheduled date falls on a non-business day, the transfer will occur the following business day

To:

Name of financial institution:       Routing Number of financial institution:  9 digits

               Account Number:

Distribution:

ACCOUNT TYPE

ACCOUNT NO. / SUFFIX

$ AMOUNT

Savings

Checking

IRA

 Credited as current year contribution.  Up to IRS limits.

Holiday Saver

Investor Saver Certificate

LOAN TYPE

LOAN NO. / SUFFIX

$ AMOUNT

  

 

 

TOTAL

  

 

Signature X_______________________________________________ Date:_____________

  

Questions about filling out this form? Please call 323-505-2600x105