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Home
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Authorization For ACH Origination (regularly transfer funds from one financial institution to another)
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By Fax:
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Complete the information requested, then print out all pages of the application and fax to our secured number: 323-505-2613
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By Mail:
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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: 2445 Mariondale Ave, Los Angeles CA 90032
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In Person:
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Bring the completed application to our office at 2445 Mariondale Ave, Los Angeles and submit it confidentially to one of our specialists.
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♦ Start or ♦ Change
Name:_____________________________________________ CSLA-FCU Account Number: ____________________________
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Home Phone:________________________ Work Phone: _______________________ Cell Phone: _____________________
I hereby authorize Cal State L.A. Federal Credit Union to originate the following ACH transaction:
From:
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Name of financial institution: _____________________________________________________________________
Routing Number of financial institution: ____________________________ (9 digits)
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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)
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If the scheduled date falls on a non-business day, the transfer will occur the following business day
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To:
Name of financial institution: ___________________________________________________________________
Routing Number of financial institution: __________________________ (9 digits)
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Account Number:_____________________________
Distribution:
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ACCOUNT TYPE
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ACCOUNT NO. / SUFFIX
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$ AMOUNT
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Savings
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_________________________
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_____________________________
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Checking
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_________________________
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_____________________________ |
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IRA
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_________________________
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__________________________________
Credited as current year contribution. Up to IRS limits.
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Holiday Saver
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_________________________
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_____________________________
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Investor Saver Certificate
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_________________________
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_____________________________
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LOAN TYPE
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LOAN SUFFIX/#
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$ AMOUNT
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____________________
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_________________________
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_____________________________
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____________________
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_________________________
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_____________________________
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TOTAL
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_____________________________
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Signature X_______________________________________________ Date:_____________
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