Bill Payer Enrollment Form

Bill Payer Enrollment

Enrollment Steps:

    1. Enroll in AFCU Online Banking
    2. Return Enrollment Form with a voided AFCU Share Draft
Checking account number (required) ___________________________

Add: _____Money Market _____Equity Line of Credit

____________________________ ____________________________
Print Member Name Print Joint Member Name

_____________________________________
Street Address, City, State Zip Code

____________________________ ____________________________
Phone Number (required) E-mail Address (required)

By providing the above enrollment information and by signing where indicated below, I authorize Atlantic Federal Credit Union (AFCU) as follows:
    a) To serve as my agent in processing payments to specified merchants and/or transfers to/from my designated account(s) pursuant to my payment and/or transfer instructions.

    b) To post such payments and/or transfers to my account(s).

    c) To deduct monthly Bill Payer Service charges (if applicable) directly from my AFCU checking account.

    d) To provide all disclosures and transmit all notices to me electronically to the E-mail address I have provided. I understand that I am responsible for notifying AFCU when there is a change in my E-mail address.
I understand that:
    a) Payments may take up to 5 business days to reach the payee and that they will be sent either electronically or by check, which is dependent upon the receiving capabilities of the payee.

    b) AFCU will not make certain payments and/or transfers if sufficient funds are not available in my designated account(s).

    c) AFCU is not liable for any loss, penalty, service fee or late charge that I may incur due to insufficient funds or other conditions that may prevent the withdrawal of funds from my account(s).

    d) I am responsible for all payment and/or transfer transactions made by any joint owner(s) on my AFCU account(s) regardless of whether they have been authorized for Bill Payment Service.

    e) This Bill Payer Service Authorization is in force until revoked by me by notifying AFCU in writing (Attn: Member Service Department, Atlantic FCU, 37 Market St., Kenilworth, NJ 07033) and that this Authorization is subject to the service Terms and Conditions, as amended from time to time.

_________________________________ ______________________
Member Signature Date

_________________________________ ______________________
Joint Member Signature Date





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