Courtesy Pay & Overdraft Protection

• Which product are you applying for?

  • Courtesy Pay
  • Overdraft Protection
  OK Which product are you applying for? is required

• I want FCCU to authorize and pay overdrafts on my everyday FCCU Mastercard® debit card, checks or ACH transactions. I realize that if I opt-in, I may revoke this coverage at any time via mail, online or by phone.

  • Yes
  • No
  OK I want FCCU to authorize and pay overdrafts on my everyday FCCU Mastercard® debit card, checks or ACH transactions. I realize that if I opt-in, I may revoke this coverage at any time via mail, online or by phone. is required

Please enter the account numbers for which Overdraft Services should apply...

• Account Number
  OK Account Number is required
• Account Number
  Optional OK Account Number is required
• Account Number
  Optional OK Account Number is required
• Account Number
  Optional OK Account Number is required

Your Information

• First Name
  OK First Name is required
• Last Name
  OK Last Name is required
• E-mail
  OK E-mail is required

Your Signature

Entering your first and last name along with today's date in the boxes below will serve as your signature for this form.

• First and Last Name
  OK First and Last Name is required

• Today's Date

  JanFebMarAprMayJunJulAugSepOctNovDec 12345678910111213141516171819202122232425262728293031 202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068206920702071207220732074
  OK Today's Date is required

Fees may apply. See Fee Schedule here for more information

This request can only be accepted from current FCCU members. After completing this form, hit "Submit" to send it to us for processing. All our forms are encrypted using the latest internet security for your privacy. Be sure to contact us with any questions.

FCCU reserves the right to require repayment immediately or on demand.

• Security Code
  OK Security Code is required