MasterCard Balance Transfer Authorization Form

Date: _____/ ___________ / _________

Member Name: __________________________________________________ Member # ___________

First Choice MasterCard Account Number ___________________________________________

Gold ☐ Classic ☐

Balance Transfer Amount $ _____________________

Receiving Creditor (Financial Institution) _______________________________

Creditor Phone Number __________________________________________________________

Creditor Billing Address ___________________________________________________________

City ___________________ State ____________ Zip Code ___________________

Account Number _______________________________________________________

Account Type: _______________________________________

(Please include copy of account statement if possible)

The words “you” and “your” means each and all those with active Classic or Gold credit cards submitting authorization for balance

transfer. The word “creditor” applies to the financial institution or company you would like to balance transfer funds. The “Words

Credit Union”, “we”, “us” and “our” refers to First Choice Credit Union.

By signing below you authorize First Choice Credit Union to balance transfer the requested amount to the receiving creditor and

you agree to the following. The Credit Union is not responsible for incorrect information such as billing address or account

numbers. The Credit Union is not responsible for returned payments. The Credit Union will only attempt the balance transfer one

time. You would need to submit a new request in the event of returned balance transfer from receiving creditor. Allow 2-14

business days for balance transfer payments to arrive at receiving creditor. Continue paying creditors until the balance transfer

appears as a credit on your account. Balance Transfers Incur interest charges form the transaction date. Balance Transfers are

subject to all terms and conditions listed in our First Choice Credit Union credit card account agreement. If the total amount you

requested exceeds your available credit limit, we may send partial payment to your creditor or cancel the balance transfer. Please

see our Credit Card Agreement for full terms and conditions for our Classic and Gold Credit Cards. We reserve the right to modify

our agreements at any time. To request a copy of the First Choice Credit Union Credit Card Agreement please contact us at 561-

641-0100 during normal business hours. You can visit us at 1055 S Congress Avenue, West Palm Beach, FL in person or mail a

written request to 1055 S Congress Avenue, West Palm Beach, FL 33406.

X____________________________________________________________________________________

Member Signature Date

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(Internal use only)

Receiving MSR/CCS ___________RSM/Management Approval _____________ Date________________

Processing MSR/CCS/______________ Date__________ Confirmation # (Tran ID) _________________

Date Entered _____________ Date Sent _________________ Resp # (if any) ____________________

Tracking Dates _________________________________________________

Rev. 09/24/2019