1481 Harlem Road Cheektowaga, NY 14206 • Phone: (716) 897-2383 • Email: memberservices@bufconfcu.com

ATTENTION: Do not use this form for transfers between Buffalo Conrail FCU accounts.

To transfer funds between Buffalo Conrail FCU accounts call us at (716) 897-2383 or use Home Banking.

Deposit Information

Buffalo Conrail FCU Electronic Funds Transfer

WITHDRAWAL OF FUNDS FROM THE FOLLOWING FINANCIAL INSTITUTION

Account Type for Withdrawal*

Withdrawal Type*

DEPOSIT OF FUNDS INTO THE FOLLOWING CREDIT UNION ACCOUNT

Control Number
/
Account Number

Credit Union Account Type for Deposit*

I understand that this authorization will remain in effect until I cancel it in writing and I agree to notify BCFCU in writing of any changes in my account information or termination of this authorization at least 10 days prior to the next billing date.

If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment will be executed on the next business day.

I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above-noted periodic transaction dates. I agree to an additional $25.00 charge for each attempt returned NSF, which will be initiated as a separate transaction from the authorized recurring payment.

I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.

I agree to the above