Saginaw County Employees Credit Union

CARDHOLDER AUTHORIZATION FORM AND
AGREEMENT FOR PREAUTHORIZED PAYMENTS
* = required field

Date:                                         Account Number*:

Full Name*
Address*
City* State* ZIP Code*  

I (we) hereby authorize Saginaw County Employees Credit Union to initiate withdrawal from the account indicated below to pay on my (our) credit card account number *.

I (we) agree that your rights in respect to each withdrawal shall be the same as if it were a check drawn on my (our) account and personally signed by either of us and that you shall be fully protected in honoring such a withdrawal. I (we) further agree that if any such withdrawal is dishonored with cause, Saginaw County Employees Credit Union, shall be under no liability whatsoever if such dishonor results in late charges or revocation of my (our) card.

Please withdrawal the funds from account #*: Savings Checking

The amount of the payment for my (our) credit card to be deducted monthly is:

The minimum payment or 3% of the balance.
The total unpaid balance.
A fixed amount greater than the minimum payment. The fixed amount to be withdrawn monthly is $ or dollars and cents. (Write out dollar and cent amount.)

 

This authority is to remain in full force and effect until Saginaw County Employees Credit Union has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Saginaw County Employees Credit Union a reasonable opportunity to act on it.

I (we) understand and agree that in order for Saginaw County Employees Credit Union to make payments requested in this authorization form, I (we) must have the payment amount available in my (our) account.

I (we) further understand and agree that Saginaw County Employees Credit Union shall not be responsible for any act or failure to act on their part, except in the case of gross negligence or willful misconduct. Furthermore, I (we) agree to hold Saginaw County Employees Credit Union harmless from any claims, liabilities, attorneys' fees and other costs and expenses of any and every kind and nature which may be incurred by them by reason of their performance under this Authorization Form.

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Signature                                                                        Date

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Signature                                                                        Date

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Accepted by: __________________________ Date: ____________

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