AFFIDAVIT OF NOTICE OF REVOCATION OF AUTHORIZATION (R07) ELECTRONIC FUND TRANSFER
HSFCU Account No.:
ACH Source No.: (credit union use) __________________
I release, indemnify, and hold harmless HSFCU from any and all liability associated with the Notice of Revocation of Authorization. I agree to monitor my account and to advise HSFCU in the event of the item posting in such a time that will allow a legal return of the item. I understand that HSFCU is not required to make the return under any agreement, written or implied.
I understand that this stop payment will expire 6 months from today’s date: _______________________, 20_____
Subscribed and sworn to before me this ____ day of __________, 20___