Dare To Compare Automatic Draft Form


DARE to COMPARE

Automatic Draft

I want more for my money? I'm switching to PFCU! It's easy!

Name _______________________________________

Address_______________________________________

City/State________________________________________

Zip ________ Phone_______________

E-mail ______________________________________

Please change the following electronic payment:

__________________________________________________

(Company to Receive Payment)

__________________________________________________

(Company Account Number)

To: Patriot Federal Credit Union

P.O. Box 778

Chambersburg, PA 17201

Telephone: 717-263-4444

PFCU Account No.___________________

Checking Savings

PFCU Routing No.: 231379979

Previous Financial Institution Account No.

____________________________

I authorize this change in Electronic Payment.

Effective Date _________________________________

Signature______________________________________

Joint Account Signature____________________________

Todays Date __________________________________

Please send this to the company that receives your Electronic Payment.

If you need additional copies for multiple drafts, please let us know.


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