ACH Origination Omaha Federal Credit Union's Automatic Deposit Authorization (FROM Another Institution to Omaha FCU) I hereby authorize Omaha Federal Credit Union, hereinafter called CREDIT UNION, to initiate a credit entry to my (our) Omaha Federal Credit Union account/loan indicated below from the financial institution named below. I (We) acknowledge that the origination of ACH transactions to my account must comply with the provisions of the U.S. law. FINANCIAL INSTITUTION SENDER INFORMATIONNAME ON ACCOUNT: FINANCIAL INSITUTION: ADDRESS Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ROUTING NUMBER ACCOUNT NUMBER ACCOUNT TYPE CHECKING DEPOSIT (SAVINGS) LOAN PAYMENT AMOUNT FIXED AMOUNT VARIABLE AMOUNT AMOUNTOMAHA FEDERAL CU INFORMATIONSTART DATE MM slash DD slash YYYY APPLY TO CREDIT UNION ACCOUNT NUMBER APPLY TO: DEPOSIT/SAVINGS SUFFIX CHECKING LOAN # IRA # CREDIT FREQUENCY Weekly Bi-Weekly Monthly Semi-Monthly Quarterly Other This authorization is to remain in full force and effect until CREDIT UNION has received written notification from me of its termination in such time and manner as to afford CREDIT UNION and FINACIAL INSTITUTION a reasonable opportunity to act on it. PRINT NAME PHONE NUMBERSIGNATURE Reset signature Signature locked. Reset to sign again DATE MM slash DD slash YYYY ****** PLEASE ATTACH A COPY OF VOIDED CHECK TO THIS FORM ******Max. file size: 32 MB.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
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