Teachers Federal Credit Union

							                                    TEACHERS FEDERAL CREDIT UNION
                                ACH ORIGINATION/REVOCATION AGREEMENT
1) ACCOUNT/MEMBER INFORMATION
                                                                               MEMBER NAME: ________________________________

                                                        TFCU ACCOUNT TO BE CREDITED: ________________________________

                                                         TFCU ACCOUNT TO BE DEBITED: ________________________________
2) ORIGINATION INFORMATION
                                                                                       AMOUNT: _________________________________

    1.       UPDATE TO EXISTING                        TRANSACTION FREQUENCY: MONTHLY ON THE_______________________

                                                                 BI-WEEKLY – Every 14 Days: ___________________________________
    2.       NEW
                                                                 SEMI-MONTHLY – ON THE 14th AND 28th: ______________________________________

                                                                 OR ON THE 15th and Last Day of the Month (28th) ____________________

                                                                 WEEKLY:________________________________________________________________

                                                          DATE TO END: __________________________________________________
                                                           (Specify Date or Indefinite)
                                                          DATE TO BEGIN PROCESSING: __________________________________
                                                           (10 Business Day Notification Process)
3) RECEIVING DEPOSITORY INFORMATION
                                                   TRANSIT ROUTING (ABA) NUMBER: ___________________________________

                                                                      INSTITUTION NAME: ___________________________________

                                                           ACCOUNT TO BE CREDITED: _________________________________

                                                           ACCOUNT TO BE DEBITED:__________________________________

                                                                 ACCOUNT NAME/TITLE: ____________________________________

                                          OTHER INFORMATION: (Savings/Checking): ___________________________________
4) REVOCATION INFORMATION
                                                                                     AMOUNT: ____________________________________

                                                 TRANSIT ROUTING (ABA) NUMBER: ____________________________________

                                                                    INSTITUTION NAME: _____________________________________

                                          OTHER INFORMATION: (Savings/Checking): ____________________________________
5) AUTHORIZATION
I hereby authorize TEACHERS FEDERAL CREDIT UNION to initiate or revoke debit or credit entries to or from the account indicated above
directly through the Electronic Payment Network. This authorization will remain in effect until written notification is received from me to terminate
or change it. It is my understanding this authorization may also be revoked by notification by the receiver and as described in the rules and
regulations specified by the NACHA (National Automated Clearing House Association). Sufficient funds to cover credits must be available in my
account two days prior to the date indicated on this form. These funds will be debited to my account and effective dated by actual settlement date.
The Credit Union will attempt to make this payment three times or up until the settlement date if funds are not available. Payment will not be
released until debit is processed to the account indicated on this form. I hereby agree to indemnify and hold harmless Teachers Federal Credit Union
from and against all claims that may arise against it by reason of acting pursuant to the foregoing authorization and agreement.

X ___________________________________________                                 ________________________________________________
            Member’s Signature                                                                      Date

_________________________________________                                     _________________________________________________
                Branch                                                                       Employee & Operator #
Revised (12/09)              Original - TFCU                         Copy - Member