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CANCELLATION OF ELECTRONIC PAYMENT SERVICE AUTHORIZATION AGREEMENT

Requirement
  • Credit union must be notified in enough time to act on the cancellation. (10 days prior to the next transaction date)
  • Form must be signed and mailed to the credit union prior to the cancellation being processed.
Instructions
  • Enter member name
  • Enter the HSFCU Account Number receiving credits or withdrawals
  • Select the Debit or Credit Authorization agreement section, which applies to the service currently being utilized.

DEBIT AUTHORIZATION AGREEMENT
  • Enter the effective date of the cancellation
  • Select the payment date to be canceled
    (must be received by ESS at least 10 days prior to the next payment date)
  • Enter the name of the Bank, Savings and Loan or Credit Union
  • Enter the account number at the financial institution being debited
  • Enter the dollar amount of the electronic payment being debited
  • Print 2 copies (retain 1 for your records)
  • Mail the signed form to:
    Hawaii State Federal Credit Union
    Attn: Webmail
    P.O. Box 3072
    Honolulu, HI 96802-3072

CREDIT AUTHORIZATION AGREEMENT
  • Enter the effective date of the cancellation
  • Select the payment date to be canceled.
    (must be received by ESS at least 10 days prior to the next payment date)
  • Select the type of account that is being credited
  • Enter the name of the Bank, Savings and Loan or Credit Union
  • Enter the account number at the financial institution being credited
  • Enter the dollar amount of the electronic payment being credited
  • Print 2 copies (retain 1 for your records)
  • Mail form to:
    Hawaii State Federal Credit Union
    Attn: Webmail
    P.O. Box 3072
    Honolulu, HI 96802-3072


Name

HSFCU Account Number


Phone Number

Daytime Phone

E-mail Address

DEBIT AUTHORIZATION

I revoke my DEBIT AUTHORIZATION AGREEMENT with Hawaii State Federal Credit Union, hereinafter called HSFCU, to debit my Checking Account or Savings Account (select one) indicated below at the depository financial institution named below, hereafter called DEPOSITORY. I would like to have this revocation to be effective as of .

Payment Date:
1st 5th 7th 10th 15th 20th 22th End of month


Bank, Savings & Loan or Credit Union


Account Number
$
Dollar Amount

CREDIT AUTHORIZATION

I revoke my CREDIT AUTHORIZATION AGREEMENT with Hawaii State Federal Credit Union, hereinafter called HSFCU, to credit my Account indicated below at the depository financial institution named below, hereafter called DEPOSITORY. I would like to have this revocation to be effective as of .

Payment Date:
1st 5th 7th 10th 15th 20th 22th End of month

Savings
Checking
Mortgage Loan
Installment Loan
Home Equity Loan


Bank, Savings & Loan or Credit Union


Account / Loan Number

Loan note number/ suffix

Share suffix

$
Dollar Amount


I understand that I am responsible for any loss or penalty that I may incur due to this revocation.

_________________
Date
_________________________
Member Signature
_____________________
Daytime Phone