* Indicates Required
PLEASE NOTE: This form does not change the contractual due date of your loan. To avoid late fees, your monthly transaction should occur prior to the monthly due date on the loan.
Your rights and responsibilities under the law are outlined in
the Federal Reserve Board's Regulation E that governs a variety
of electronic transactions. In general, you are protected from loss
providing you are responsible in reading your account statements
and reporting any problems and errors promptly. You were
provided with a Regulation E disclosure when you opened your
account with us.