Automatic Transfer Form
Member Name ________________________________
Home Phone # ____________________
Work Phone # ____________________
.
Automatic Transfer #1
Select One:
Automatic Transfer #2
Select One:
Automatic Transfer #3
Select One:
Transfer Amount
$
Transfer Amount
$
Transfer Amount
$
From Account Number & Suffix
_
From Account Number & Suffix
From Account Number & Suffix
To Account Number & Suffix
To Account Number & Suffix
_
To Account Number & Suffix
_
Transfer “To” Account Name
Transfer “To” Account Name
Transfer “To” Account Name
(If Different than the “From” Account)
(If Different than the “From” Account)
(If Different than the “From” Account)
_
_
_
Transfer Type and Start Dates
For first and second mortgage loan
payments, you may select only
“monthly” option.
Transfer Type and Start Dates
For first and second mortgage loan
payments, you may select only
“monthly” option.
Transfer Type and Start Dates
For first and second mortgage loan
payments, you may select only
“monthly” option.
□ Monthly (same date each month)
Start Date __________________
□ Monthly (same date each month)
Start Date __________________
□ Monthly (same date each month)
Start Date __________________
□ Semi-Monthly (twice per month)
1st Transfer
Start Date __________________
2nd Transfer
Start Date __________________
□ Semi-Monthly (twice per month)
1st Transfer
Start Date __________________
2nd Transfer
Start Date __________________
□ Semi-Monthly (twice per month)
1st Transfer
Start Date __________________
2nd Transfer
Start Date __________________
□ On Loan Due Date (will be
attempted until transfer is successful)
□ On Loan Due Date (will be
attempted until transfer is successful)
□ On Loan Due Date (will be
□ Bi-Weekly (every 14 days)
Start Date ____________________
□ Bi-Weekly (every 14 days)
Start Date ____________________
□ Bi-Weekly (every 14 days)
Start Date ____________________
□ Weekly (every 7 days)
Start Date ____________________
□ Weekly (every 7 days)
Start Date ____________________
□ Weekly (every 7 days)
Start Date ____________________
If funds are not available on the account,
Bi-Weekly and Weekly transfers will be
attempted daily until the transfer is completed,
therefore, the date of the next transfer may
change.
If funds are not available on the account,
Bi-Weekly and Weekly transfers will be
attempted daily until the transfer is completed,
therefore, the date of the next transfer may
change.
If funds are not available on the account,
Bi-Weekly and Weekly transfers will be
attempted daily until the transfer is completed,
therefore, the date of the next transfer may
change.
Start Date __________________
Start Date __________________
attempted until transfer is successful)
Start Date __________________
Signature X ___________________________________________________ Date __________________
By signing this form you authorize BrightStar Credit Union to perform automatic transfers as indicated. This authorization shall
remain in force until you provide a written notice of cancellation in accordance with the policies and procedures of the Credit Union.
Employee Initials: ______________
Date: _____________
Revised 12/2015