Secure ACH Payment Authorization Form


Payments made Monday-Friday before 1:00 pm will be effective the next business day. Payments made after 1:00 pm, weekends, and holidays will be made on the 2nd business day.

Please note that as of June 1, 2015 there will be a $5 fee for this service. To discuss other payment options, please call 800-562-7328 to talk with a Member Service Representative.

Rockland Federal Credit Union Account Number:
Name on Account:
Transaction Amount: $
A $5 fee will be assessed for this service as of June 1, 2015.
 
Financial Institution to withdraw funds
Bank Name:
9-digit Routing and Transit Number:
Bank Account Number:
 
Contact Information
Withdrawal Authorized By:
Address:
City:
State:
Zip Code:
Phone Number:
*Please note: We will use this phone number to contact you with any processing issues.
Email Address:
Confirm Information
 
Before pressing the "Submit Payment" button below, please confirm all of your information is correct. Failure to do so may delay the processing time for your payment. Payments made Monday-Friday before 1:00 pm will be effective the next business day. Payments made after 1:00 pm, weekends, and holidays will be effective on the 2nd business day.

** If you are attempting to cancel a payment, please call (781) 878-0232 or (800) 562-7328 immediately.

By submitting this form, I hereby authorize Rockland Federal Credit Union to debit my account. I understand this is a one-time authorization. I also acknowledge that I am the owner on the account entered above in which the funds will be withdrawn from. I may cancel this authorization at any time as long as it is given in such a time and manner that allows the Credit Union to act on the stop Payment order prior to the debit entry.