Automatic Payment Authorization Application


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 reduce account fraud.

Baltimore County Employees Federal Credit Union
23 W. Susquehanna Avenue
Towson, Maryland 21204


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:

To be credited to:

Frequency:
- - (Month/Day/Year)

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 is to remain in full force and effect until BCEFCU has received written notification from me (or any owner of the account) of its termination in such a time and in such a manner as to afford BCEFCU and/or the Depository Financial Institution a reasonable opportunity to act on it.

 
X _______________________________________________________ ________________________
Print Name Daytime Phone
X _______________________________________________________ ________________________
Member's Signature Date

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

ABA/Routing Number: 2520-7575-7