Cancellation of Authorization Agreement for Automatic Payment
Baltimore County Employees Federal Credit Union

Please fill out the form on your screen, print out and mail to the address listed below. The Credit Union requires an INK Signature for this application. We will not accept a faxed copy. This helps to reduce account fraud.

I hereby cancel my authorization for Baltimore County Employees Federal Credit Union to withdraw my scheduled loan payment from my account with another financial institution (ACH Debits) as well as initiate (if necessary) credit entries and adjustments for any debit entries in error (ACH Credits).

This cancellation applies to:

_________________________________________________________________________
   
_________________________________________________________________________

At _________________________________________________________________________ (Depository Financial Institution)

9 digit Routing Number

Which is credited to:
Account Number
Loan Number
Amount $
Frequency Monthly Biweekly Weekly One time only
Effective Date Requested for Cancellation


I agree that I am responsible and hold BCEFCU harmless for all fees against my account(s) as a result of this agreement.

This authorization will remain in full force and effect until BCEFCU and/or the Depository Financial Institution has a reasonable opportunity to act on it.

Print Name: _____________________________________________________________ Daytime Phone #: ___________________________________

Member's Signature: _____________________________________________________________ Date: _________________________________




Baltimore County Employees Federal Credit Union
23 W. Susquehanna Ave., Towson, MD 21204
410-828-4730

ABA/Routing Number: 2520-7575-7