Download Visa Credit Card Auto Pay Application

VISA CREDIT CARD AUTOPAY APPLICATION
Instructions:
1. Fill out the VISA Credit Card Autopay Application.
2. Applications must be received 7 business days before the bill is due.
3. Send completed forms to Card Services Help Desk.
Terms and Conditions:
A: Payment can be made from any checking or savings account from most financial institutions in the United States.
B: If there are insufficient funds in your account on the specified payment dates, Arizona State Credit Union reserves the right to take
payment in full when funds become available.
C: This authority will remain in effect until you notify us in writing to cancel it, allowing reasonable opportunity to act, or if Arizona State
Credit Union cancels pre-authorization.
D: Payment terms are according to the following: Statement New Balance less any credits posted up to 2 days prior to payment date.
Statement Minimum Payment or total amount due 2 days prior to payment date, whichever is less. If statement Minimum payment is greater
than fixed amount, payment will be the minimum payment amount. If statement New Balance is less than fixed amount, payment will be
amount of New Balance.
E: If you choose to pay less than your statement balance, finance will be assessed according to your Visa Credit Card Agreement.
Application Information:
Name
Account #
Mailing Address
City
State
Email Address
ZIP Code
Day Phone Number
16 digit VISA Credit Card Number
Auto Pay Account Section: Check One
Pay from my Checking Account
Routing/Transit
Pay from my Savings Account
Account #
Auto Pay Amount Selection: Check One
Please pay the entire New Balance shown on my monthly statement.
Please pay the Minimum Payment Due Shown on my Monthly Statement.
Please pay the following fixed dollar amount every month $
Signature
Rev. 7/2014
Date
Help Desk
Card Services