AUTOMATIC LOAN PAYMENT REQUEST

Use this form to establish an automatic payment from a checking or savings account to a Vantage West loan. Please allow 10 days for processing.

If you have an automatic transfer set up in your Vantage West Online Banking account, please delete the transfer to avoid a double payment posting.

You can also print this form. Once completed, please turn it in to a branch or fax it to (520) 917-2433 or (520) 751-7089 (1st Mortgage, 2nd Mortgage, HELOC, or Business).

My Loan

First Name *

Last Name *

Email Address

Member Account # *

Loan ID *

Primary Member's Name (if different than above).

For what type of loan would you like to set up automatic payments? *

1st Mortgage

2nd Mortgage / HELOC

Business Loan

OTHER

Please indicate reason for request (check only one).

START a new automatic loan payment.

First Payment Date (NOTE: Must be 10 days or more from today!) * 🛈 +

NOTE: For credit card payments, lines of credit (LOC), and home equity lines of credit (HELOC), your payment date must be the due date.

Name of Financial Institution to Debit (ex: Bank of America, Chase, USAA, etc) *

* Routing & Transit #
(This is the 9-digit number found on the bottom of your checks.)

Account Type *

Checking

Savings

Account # *

Name on Account *

STOP my automatic payment. (Notification must be received at least ten business days prior to the scheduled payment date.)

Temporarily cancel my automatic loan payment.

Automatic transfers to resume on... * 🛈 +

CHANGE the amount/financial institution/account # of my existing automatic loan payment.

CHANGE PAYMENT TO COME FROM...

First Payment Date (NOTE: Must be 10 days or more from today!) * 🛈 +

NOTE: For credit card payments, lines of credit (LOC), and home equity lines of credit (HELOC), your payment date must be the due date.

Name of Financial Institution to Debit (ex: Bank of America, Chase, USAA, etc) *

* Routing & Transit #
(This is the 9-digit number found on the bottom of your checks. Please enter one number per box.)

Account Type *

Checking

Savings

Account # *

Name on Account *

Payment Amount

Monthly Payment Amount *

I hereby authorize Vantage West Credit Union (VWCU), and its successors, assigns, authorized agents or any entity servicing my loan on their behalf (hereinafter called The Lender) to initiate debit or credit entries or adjustments to my account as indicated at the financial institution named above. I understand that this authorization remains in full force and effect until VWCU has received notification from me. VWCU requires verification in writing to be received within 10 days of the scheduled payment date.

Member Signature *

clear

For more information, please contact our Member Information Center at 520-298-7882 or 1-800-888-7882, or write to Loan Servicing, PO Box 15115, Tucson, AZ 85708.