Prompt Pay

PROMPT PAY

This Authorization provides a One-Time Payment by Debit Card from your OTHER Financial Institution.

A $10.00 Fee will be accessed for this payment service and will be charged to the Card in addition to Payment Amount.

What to know before you start:

Western Division Member # and Suffix #
Debit Card from your other Financial Institution

WESTERN DIVISION MEMBER INFORMATION

First Name *

Last Name *

Mobile Phone # *

Email *

Member/Account# *

Account Suffix # *

Payment Amount $ *

The payment will be rejected if the following criteria is not met or the captured image is not legible.

Place the Card on a flat surface (do not hold the Card).
Take picture from directly above in a HORIZONTAL position.
All four corners of the card must fill the frame and be in focus.
Card without a valid expiration date will not be accepted.
Back of Card must have a signature.
Card must be in the Name of the Account listed above.

Front of Card *

Click or drag & drop image here to upload

Back of Card *

Click or drag & drop image here to upload

I have read and agree to the following terms: *

I am authorized to make this request and authorize Western Division to initiate a debit and/or cash advance from my Card for payment amount and service fee to the account listed above.

Transaction Request Received ******* DO NOT RESUBMIT *******

Transaction requests are processed during normal business hours Monday - Friday (excluding holidays). Your payment can be verified through your Online Banking within one business day.