Name: (Last, First, MI)
Account number:

Transfer Authorization
Please tell us what accounts you want us to authorize transfers into from your account:

To account #   To account #
PIN: (Select 4 numbers - same as MATT PIN if you know it)
Password: (6 to 10 characters)

By signing below, I request that Mid American Credit Union establish the Transfer(s), PIN and Password referred to above. I also understand that Mid American Credit Union, unless notified in writing to the contrary, may consider anyone using my password to be an authorized user.

Signature of account owner ________________________________Date_______________

(Please read disclaimer under Getting Started before signing.)

Daytime phone number:
E-mail Address:

Please mail to: Mid American Credit Union, 8404 West Kellogg Drive, Wichita, KS 67209