Electronic Bill Payer Sign-Up Form
Complete this form and mail, fax, or drop it off at the credit union.
| Name: _______________________________________________________ | |||||||||
| Soc. Security #: _______________________________________________________ | |||||||||
| E-mail Address: _______________________________________________________ | |||||||||
| Postal Address: _______________________________________________________ | |||||||||
City: ___________________ State: _____ Zip: ______________ |
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| Type of Account: _______________________________________________________ | |||||||||
| Account Number: _______________________________________________________ | |||||||||
| Co-owner of Account: _______________________________________________________ | |||||||||
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| Authorization I authorize Tri-Point Federal Credit Union to post EBP transactions to the account indicated on this enrollment form. I further understand that the service fee(s) associated with the chosen plan will be directly debited from the same account. I understand that I am in full control of my account. If, at any time, I decide to discontinue the service, I will provide written notification to Tri-Point Federal Credit Union. My use of EBP signifies that I have read and accepted all of the terms and conditions of EBP service. I understand that payments take an average of 5 business days to reach the payee, and that payments may be made electronically or by mail. Tri-Point Federal Credit Union is not liable for any service fees or late charges levied against me. I also understand that I am responsible for any loss or penalty that I may incur due to a lack of sufficient funds (NSF fee $20.00) or other conditions that may prevent the withdrawal of funds from my account. |
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| Signature: ________________________________________ | |||||||||
| Thank you for signing up to use EBP service. Your start-up kit will arrive via U.S. Mail within 5 to 7 days. |
We
do business in accordance with the
Federal Housing Law and the Equal Credit Opportunity Act.
