The Portal

Direct Deposit Agreement Form

I authorize FCBCLA to initiate automatic deposits to my account at the financial institution named below. I also authorize FCBCLA to make appropriate debits from this account in the event that a credit entry is made in error.

 I agree not to hold FCBCLA responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

For changes or updates to this authorization, select the AUTHORIZATION TYPE "Update" option.  To cancel this authorization, select the "Cancel" option .    

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*AUTHORIZATION TYPE:
*Bank Account Type:
*Name of Financial Institution:
*Banking Routing Number:
*Bank Account Number:
*Approval - Check here:
*Approval - Date: