NEW Member Application - Financial Institution

Company Information:

Organization
Address
City State Zip
Phone
Fax
Website
Member Type
Institution Type
Asset Size (actual)
ABA Routing Number

Key Contact Information:

First Name Last Name
Title
Your Email
Your Phone

Executive Contact Information:

First Name Last Name
Title
Your Email
Your Phone

Billing Contact Information:

First Name Last Name
Title
Your Email
Your Phone

Operations Contact Information:

First Name Last Name
Title
Your Email
Your Phone

Compliance or Audit Contact Information:

First Name Last Name
Title
Your Email
Your Phone

Card Operations Contact Information:

First Name Last Name
Title
Your Email
Your Phone

Check Operations Contact Information:

First Name Last Name
Title
Your Email
Your Phone

Wire Operations Contact Information:

First Name Last Name
Title
Your Email
Your Phone
The PaymentsFirst membership year runs from January 1st through December 31st and dues are payable on January 1st each year. Dues information will be sent to each member 30 days prior to the due date. Unless otherwise terminated by PaymentsFirst, this membership is to remain in full force and effect until Organization has given PaymentsFirst 90–day written notice of its membership termination. Dues are non-refundable once the current billing year is in force.
I (we) hereby authorize PaymentsFirst, to initiate debit entries for the above dues to the transaction account and the depository financial institution named below.
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