Members Name *

First Name

Last Name

Start Date *

Loan Payments Are Due The Last Day of Each Month

MM

DD

YYYY

I consent to processing this transaction as a Cash Advance *

If NO, RESCU Cannot Set Up Automatic Payments

YES

NO

I consent to processing this transaction on a continued and monthly basis, until I cancel this request within 3 business days of desired date of transaction, in writing *

If NO, RESCU Cannot Set Up Automatic Payments

YES

NO

I will opt into text or email services for monthly payment confirmation notifications. *

If NO, RESCU Cannot Set Up Automatic Payments

YES

NO

I acknowledge, if the payment is declined three months in a row, the account will be removed from RESCU payment program *

If NO, RESCU Cannot Set Up Automatic Payments

ACKNOWLEDGE

I acknowledge there may be additional fees associated with this transaction, NOT by RESCU, by financial institution that issued this card *

RESCU OFFERS THIS SERVICE FREE OF CHARGE

ACKNOWLEDGE

If the payment day is a weekend or holiday. Transactions are posted on the next business day. RESCU will effective date the payment for the day the transaction was requested *

ACKNOWLEDGE