Virtual Branch Cross Member Transfer Consent

Please complete this form to grant permission for another credit union member to conduct transfers to your credit union account.

Cross Member Transfer- transfer of funds between two separate Financial Assurance Federal Credit Union member accounts. There is no charge for this service. From Virtual Branch, cross member transfers can be done instantly and/or scheduled ahead of time (one-time and recurring).

*Indicates a required field.

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Please allow the member (below) to transfer funds to my: * Savings (Sfx A) Checking (Sfx 0) Loan All Shares/Loans
Please specify if you would like the member to have access to your account balance(s): * Yes No
YOUR ACCOUNT INFORMATION ("TO" ACCOUNT):
Your Member Account Number	* Enter your credit union account number.
First Name	*
Middle Initial
Last Name	*
Social Security Number	*
Phone Number	*
Email Address	*
MEMBER BEING GIVEN PERMISSION TO TRANSFER FUNDS TO YOUR ACCOUNT ("FROM" ACCOUNT):
2nd Member Account Number	* Enter the account number of the member who will be transfering money to you.
First Name	*
Middle Initial
Last Name	*
Phone Number	*
Email Address	* Please provide a valid email address for the member. Once this form is submitted, they will be notified of your request by our automated email system.
I,.* (Enter First & Last Name), the undersigned, do depose and say that I am the lawful owner of account listed above under "Your Account Information". I, therefore, request Financial Assurance Federal Credit Union to grant permission to the account holder ("From" Account) to conduct cross member transfers to my account(s). The member will have access to my account balances from Virtual Branch, and will only have the ability to transfer money TO my account. I agree to hold Financial Assurance Federal Credit Union harmless of and from any loss, damages, claim and expense, which may be sustained or incurred by Financial Assurance Federal Credit Union in respect to the hereinabove requested cross member transfer setup.* Yes, I agree to and have read the above paragraph stating the terms and conditions of Virtual Branch cross member transfers.
ELECTRONIC FORM SUBMISSION AGREEMENT: By submitting this form I am verifying the following: 1. The above information entered has indeed been entered by myself, the account owner or joint owner, and that submission of this form gives full authority to conduct the transaction requested above. 2. I understand that I do have the option or right to submit this form in the paper form, which is available either through our website at www.fafcuny.org and/or upon request by contacting the credit union. 3. I understand that I exercise the right to withdraw consent to have records provided electronically, including any conditions, consequences, or fees associated with doing so. To withdraw consent I must submit written documentation with my request and verify receipt of its retrieval. 4. Entering my first and last name in the Electronic Signature field stands as the equivalent of a handwritten signature. Therefore, by entering fraudulent or false information, you are commiting forgeryy and are subject to the equivalent applicable laws and penal action. * Yes, I agree to the terms and conditions of submitting this form Electronically as outlined in the guidelines above.
Electronic Signature (please print your first and last name) *
Date *
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