Bank Draft Authorization Form

ARKANSAS LAW ENFORCEMENT UNION
I.U.P.A. LOCAL 880, AFL-CIO
Post Office Box 1432
Malvern, AR 72104-1432
Telephone (870) 535-2566 | Toll free (877) 880-2538 | E-mail Us

Fill in this form, print, sign it and mail it to ALEU along with a Voided Deposit Ticket and a check for $25.00 payable to ALEU.
You must also print and complete a Membership Application Form !

Pine Bluff National Bank
Authorization agreement for prearranged payments.

I (we) hereby authorize Pine Bluff National Bank to initiate debit entries to my (our) account indicated below and the bank named below, hereinafter called BANK, to debit the same to such account.

This authority is to remain in full force and effect until BANK has received written notification from me (or either of us) of its termination in such time and in such manner as to afford BANK a reasonable opportunity to act on it. A customer has the right to stop payment of a debit entry by notification to BANK prior to charging account. After account has been charged, a customer has the right to have the amount of an erroneous debit immediately credited to this account by BANK up to 15 days following issuance of statement or 45 days after posting, whichever occurs first.

PART 2: Fill out completely, include a check payable to ALEU and a voided deposit slip from the account you want to automatically pay from.

I hereby become a member of the Arkansas Law Enforcement Union and authorize the ALEU to have Pine Bluff National Bank to initiate debit entries to my (our) account indicated and the named, to debit the same to such account. I hereby authorize my bank to deduct $25.00 from my account on the 15th of each month and any such change in dues certified by the Treasurer of the ALEU. This is to remain in force and effect until ALEU received written notification from me.

ARKANSAS LAW ENFORCEMENT UNION USE ONLY

*This key is property of ALEU IUPA Local 880, and must be returned upon request.