ACH Cancellation Request

Between your IBEW UW FCU account and your account at another Financial Institution.

Member Name *

Member Account Type:

Share

Checking

Loan

Member Account # *

Member Suffix *

Amount of Cancellation *

Date Transfer Normally Occurs *

By checking this box, I wish to cancel my ACH origination noted above.

I understand that the cancellation notice must be given at least ten (10) business days prior to the scheduled date of the transaction.

Effective Date of Cancellation *

FOR CU USE ONLY

Received by Employee ID

Processed by Employee ID

Date