Select the type of authorization agreement you are requesting:

NEW CHANGE CANCELLATION

I (we), hereby authorize First Federal Bank to initiate debit entries to my (our) bank account, at said financial institution, as indicated below and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of US law (Complete name section below)
Name:
Phone Number:
Email Address:

Account Type:

Checking Savings

Amount $:		Name of Financial Institution:
City/State:		Transit/ABA Number:
Account Number:

Amount $:		First Federal Bank Account Number:
Effective Date:

Time Frame:	Monthly Other: Describe Frequency Below
Other Frequency:

This authority is to remain in full force and effect until FIRST FEDERAL BANK has received written notification from me (or either of us) of its termination in such time and such manner as to afford FIRST FEDERAL BANK and the financial institution a reasonable opportunity to act on it. Send written termination requests to First Federal Bank, Attn: Operations Department, PO Box 1049, 200 E Divine St., Dunn NC 28335 or deliver to your local branch office. I understand that if corrections in the debit amount are necessary, adjustments to my account (credits or debits) may be necessary. If the initial amount authorized is pursuant to my loan obligation, the amount may be changed at any time by FIRST FEDERAL BANK due to changes in escrow, rate, fees, assessed, etc. (This agreement is governed by the rules of the National Automated Clearing House Association (Nacha).

By selecting the checkbox and submitting this Authorized Agreeement for Preauthorized Transfers request form, I Consent and Agree that I have electronically signed this form and further agree my signature on this document is as valid as if I signed the document in writing: