COURTESY PAY PROGRAM “OPT-OUT” FORM
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.

PURPOSE: You must complete questions 1, 2, and 3 and select either Choice A or B.

If you do not want the credit union to pay your overdrafts under its Courtesy Pay Program mark an “X” at CHOICE A. If you receive a direct deposit of Social Security or other Federal benefits and do not want the credit union to apply these funds to your overdrafts, mark an “X” at CHOICE B. Do not complete this form if you have applied for and received a separate overdraft line of credit with the credit union. This form will not affect any overdraft lines of credit.

Member Name:
Checking Account #
Is this a Joint Account? Yes No


CHOICE A:
I/we do not want the credit union to pay my /our overdrafts under the Courtesy Pay program. Return any overdrafts unpaid that I/we may write. If I/we overdraw my/our account, I/we understand that I/we will be charged an overdraft fee as well as fees imposed by merchants and collection agencies in addition to ultimately paying the overdrawn share draft.

CHOICE B:
I/we receive a direct deposit of Social Security or other Federal benefits. I/we do not want the credit union to apply these direct deposit payments to pay any of my/our overdrafts. I understand that I/we must opt out of the Courtesy Pay program for this reason.




Member Name: _____________________________________________________________ (Please Print)

Member's Signature: _____________________________________________________________ Date: _________________________________


Joint Owner Name : _____________________________________________________________ (Please Print)

Joint Owner Signature: _____________________________________________________________ Date: _________________________________




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

ABA/Routing Number: 2520-7575-7