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Sign and complete this form to authorize Lifetime Federal Credit Union to make a one time ACH debit to your checking or savings account to fund a new account with Lifetime Federal Credit Union.

By signing this form, you give us authorization to debit your account for the amount indicated on or after the indicated date. This is an authorization for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

I, *, authorize Lifetime Federal Credit Union to debit my account indicated below for $ * on * This payment is to be deposited to my account at Lifetime Federal Credit Union as an opening deposit.

Billing Information

Account Information

I attest I am the sole or joint owner of the above account. I understand that because this is an electronic transaction, these funds will be withdrawn from my account as soon as the date specified above, or up to 3 business days following receipt of form. I understand that the payment maybe rejected by above mentioned financial institution for reasons determined by my financial institution. If the opening deposit is returned for insufficient funds or other reasons beyond the control of Lifetime Federal Credit Union, it will be my responsibility to make the opening deposit within 30 days of opening of the account. I acknowledge that the origination of ACH transaction to my account must comply with the provisions of U.S. law.