I authorize Christian Community Credit Union (CCCU) to debit my checking account for my CCCU credit card payment. I understand that the payment will be deducted approximately 25 days after the closing date of the statement.

Minimum Payment Due

Total Amount Due

Fixed Payment Amount $ or minimum payment whichever is greater.

I understand and agree that in order for CCCU to make any payments requested in this Authorization Form, I must have the payment amount available in my account, or my account may be assessed a fee. If this occurs three times, the automatic transfer will be automatically revoked.

I further understand and agree that CCCU shall not be responsible for any act or failure to act, except in the case of gross negligence or willful misconduct. Furthermore, I agree to hold CCCU harmless from any claims, liabilities, attorneys' fees and other costs and expenses of any and every kind nature which may be incurred by them by reason of their performace under this Authorization Form.

CCCU Routing No. 322274831

Another Financial Institution Routing No.