Member FDIC - Equal Housing Lender

Privacy Statement

Overdraft Protection from Another Account Form
Submitter Information (Required)
First Name
Last Name
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Contact Information
Phone Number:Email Address:

Mailing Address

We will not update our records with this information. If this information needs updated, please submit an "address/contact change form".

Contact Preference
If we have questions about this form, how would you like us to contact you? (required)
Transfer From:
Account Number:
Account Type:
Transfer To:
Checking Account Number:
Disclosure & Authorization
The transfer will occur in increments of $50.00 per occurrence.

Limitations:  Transfers to cover overdrafts are included in the six (6) withdrawals permitted from your statement savings and money market accounts during any four (4) week or similar period.  Excess transactions are subject to a $15.00 excess transaction fee (per occurrence).

Fees:  A $10.00 fee will be charged to your checking account per occurrence (if the transfer is coming from a checking or savings account).  

Authoriztion:  If I do not have enough funds in my account to pay items presented against that account, I authorize the Bank to automatically transfer funds into my account to cover any amounts overdrawn.  The Bank may continue to make such transfers until I notify the Bank in writing to stop.  I am an authorized signer on each account listed above.  This agreement is subject to the terms and conditions contained in the Deposit Agreement and Disclosure.  The Bank (at their discretion) may make one transfer to cover each overdraft or one transaction to cover a number of overdrafts during the same day.  If this authorization chnages any prior authorization, the prior authorization is cancelled and I instruct the Bank to follow this authoriztion.  I then acknowledge that if there is not enough funds in mt account to cover the amount overdrawn then the transfer may not be made and the Bank may treat the item as a nonsufficient funds (NSF) items and process as such.  I understand theat the Bank does not need to notify me of automatic transfers.  I understand that I can call the Bank to find out whether or not a transfer has been made.  I also understand that I am responsible for the disclosed fees, late charges, penalties, additional interest or any charge or amoutn related to items returned becasue of insufficient funds.  The Bank shall not be responsible is an automatic transfer is not made.  


Additional Instructions: