I (we) hereby authorize Financial Federal Credit Union, hereinafter called Credit Union, to initiate withdrawals from the account indicated below, hereinafter called Depository, to make payments to the following Credit Union Visa or Mastercard account:

Visa Account # 4112 - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

Mastercard Account # 5496 - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

Please withdraw my credit card payment from the following depository account:

Credit Union or Bank name ___________________________________________________________

City ________________________ State ____________ Telephone ( ) __________________

Bank Routing/Transit number ____ ____ ____ ____ ____ ____ ____ ____ ____
(Call your financial institution if you don't know)

Account No. __________________________
  Savings
  Checking

I want payment to be made _________ (choose 1-25 days) after the statement closing date.
(If payment date falls on a Saturday or holiday, payment will be the next processing day).

There is no fee for this service, however, if your account has insufficient funds to make the payment, a $20.00 payment return fee will be charged to your credit card account.

The amount of the payment for my credit card to be deducted monthly is (CHECK ONE):

  The minimum payment due.

  The total amount due.

  A fixed dollar amount which is greater than the minimum required payment. PLEASE SPECIFY THE FIXED PAYMENT AMOUNT TO BE DEDUCTED MONTHLY:
(write out dollar and cent amount)
$___ , ___ ___ ___. ___ ___

  A fixed percentage which is greater than the minimum required payment. PLEASE SPECIFY THE PERCENTAGE OF THE ACCOUNT BALANCE, AS OF THE STATEMENT CLOSING DATE, THAT WILL BE DEDUCTED FOR PAYMENT EACH MONTH: ______%

I (we) agree the Credit Union's rights with respect to each withdrawal shall be the same as if it were a check drawn on my (our) depository account and personally signed by either of us. The Credit Union shall also be fully protected in honoring such withdrawal.

I (we) understand and agree that in order for the Credit Union and the Depository to make payments requested in this Agreement form, I (we) must have the payment amount available in my (our) depository account.

I (we) further understand and agree that if any such withdrawal is dishonored, the Credit Union and the Depository shall be under no liability whatsoever if such dishonor results in late charges or revocation of my (our) card.

I (we) agree to hold the Credit Union and the Depository harmless from any claims, liabilities, attorney's fees and other costs and expenses of any kind and nature by reason of their performance under this Agreement form.

This authority is to remain in full force until I (we) provide the Credit Union and Depository with written authorization requesting that a change be made or that the periodic payments be terminated. I (we) must provide this written authorization as to the change or termination so that it be received by the Credit Union and Depository at least 30 days prior to any change or termination requested.

______________________________	_____________________________	_________
Print name on account	Signature	Date
______________________________	_____________________________	_________
Print co-applicant's name on account	Signature	Date

Attach voided check or deposit slip here
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___________________________________________________

Please sign & return this form along with a voided check or deposit slip.
Mail to:
Financial Federal Credit Union
Attn: Credit Card Department
22 E. Flagler Street
Miami, FL 33131
Telephone (305) 577-1328 or 1-800-727-5626