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.


Equal Housing Lender NCUA Insured, Equal Opportunities Lender America's Credit Union