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Please select what day of the month you would like to have the transfer occur on below. Enter the day of the month you would like the transfer to occur i.e. 1st, 5th, 10th or 15th

By signing this form you authorize the Beta Phi Chapter to begin transfering funds in an effort to maintain membership. In order to terminate this contract formal written notice must be submitted to the Beta Phi Chapter. This transfer will be made between the Beta Phi Chapter, the Beta Phi Chapter's financial institution (Mechanic and Farmers Bank), and I. I can stop payment of any entry by notifiying my financial institution 3 buisness days before my account is charged. I can have the ammout of an eroeous chage immedieately creddited to my accoupt up to 15 dyas following issuance of my financial institution statement or 60 days after posting, whichever occurs first. I aslo acknowledge recipt of full discloser as it pertains to the electronic transfer service. This transfer is subject to good account standing and may be terminated at the bank's discretion. Return item charges also apply to returned drafts.

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