Small Donor ACH Origination Form

* - Indicates required fields

Does your Local have an account with DFDFCU? * Yes No

Authorization

This authorization is to remain in full force and effect until the credit union has received written notification from me or any member on the agreement of its termination in such time and in such manner as to afford the credit union and depository a reasonable opportunity to act on it. I am aware, as the "Originator" on this agreement, that I must notify the credit union in writing of any changes or termination of preauthorized payment. The credit union reserves the right to cancel this agreement at any time.

Name of Local *

Local Number *

Email *

Signee First Name *

Signee Last Name *

Date *

Small Donor ACH Origination Form

How to use the Ink Signature