Electronic Fund Transfer Form
229 S Colorado Avenue.
PO Box 41. Haxtun, CO 80731
Phone: 970-774-7396  •  Fax: 970-774-7668


Form Type

New Transfer       Update Existing Reoccurring Transfer       Cancel Existing Reoccurring Transfer

For ‘Update..’ and ‘Cancel…’ options, please input sufficient account and transaction details for credit union staff to verify which reoccurring transfer to Update or Cancel. Insufficient details may prevent or delay the processing of this form.


HCFCU Member Information

Name:

Address:

City:

State:

Zip Code:

Phone:

Account Number:

Type of Account:

Savings Checking Loan

Social Security #:

 

Financial Institution Information

Name of Financial Institution:

Address:

City:

State:

Zip Code:

Phone:

Name on Account:

Account Number:

Routing Number:

Type of Account:

Savings Checking Loan
Transfer of Funds
Dollar Amount:

Transfer Option:
ACH (Electronic)
No Fee for ACH Transfer; Funds clear in 2-3 Days 		Wire (Outgoing Only, Not Reoccurring)
$25.00 fee for Wire Transfers; funds clear Same-Day

 
Move Funds to HCFCU (Credit) Move Funds from HCFCU (Debit)

Frequency:
One Time Weekly Bi-weekly Monthly

Effective / Start Date::


Submit Application
By completing this form you authorize Haxtun Community Federal Credit Union (HCFCU) to initiate the following debit or credit entries to your account(s) indicated below at the depository financial institution names below, hereafter called ‘Financial Institution,’ and debit or credit the same to such account. You acknowledge that origination of ACH transactions to my account must comply under the rules of the Electronic Payment Association (NACHA) and with the provisions of U.S. law. Further, you understand this Agreement supplements the other terms , conditions and related disclosures associated with your account at HCFCU, which you have previously received and agreed to. Authorization will require funds to be available in the account prior to origination to allow reasonable time for processing on the requested date. Entries returned due to non-sufficient funds may be charged a fee, as set forth in HCFCU’s Fee Schedule. This authorization will remain in full force and effect until HCFCU has received written authorization of its termination in such time and manner as to afford HCFCU and the named ’Financial Institution’ a reasonable opportunity to act upon it; or should funds be applied directly to a loan—at which time this loan has been paid in full. HCFCU reserves the right to revoke this agreement. From time to time HCFCU may need to temporarily suspend processing of a transaction, which might result in delayed settlement and/or availability or entries. HCFCU shall be liable only for its gross negligence or willful misconduct in performing these services. We will not be liable for instance, if: Your account has insufficient funds, the funds are subject to legal processes or other encumbrances or other circumstances beyond our control (such as flood, fire, technical malfunction) prevent the transfer, despite the reasonable precautions we have taken. You acknowledge that: This authorization is to remain in full force and effect until the Credit Union has received from you written notification of its termination in such a manner as to afford the Credit Union a reasonable opportunity to act upon it. The Credit Union may unilaterally terminate this authorization in cases of excessive returns, invalid account information, or abuse of any sort on my part. Even when any loan(s) has been paid in full with a recurring ACH, the debits will continue from the financial institution listed above without delay and the amount will be deposited into my regular share account at the Credit Union. In the event that the date my ACH falls on a weekend, it will be processed and credited to my account at HCFCU on the last business day preceding the ACH's normal processing date.