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Meadow Gold
Employee’s
Credit Union
Bill Payment Setup Request Form
Fax: 801-975-8022
Mail: Meadow Gold Employee’s Credit Union
3691 West 1987 South
Salt Lake City, UT 84104
Please completely fill out the form and either fax or mail to the Credit Union.
| Account #
|
___________________________________
|
Name |
___________________________________
|
Address |
___________________________________
|
City, St, Zip |
___________________________________
|
Home Phone # |
___________________________________
|
Work Phone # |
___________________________________
|
Social Security # |
___________________________________
|
Birth Date |
___________________________________
|
E-mail Address |
___________________________________
|
Mother’s Maiden Name |
___________________________________
|
By signing below I’m requesting access to the Meadow Gold Employee’s
Credit Union Bill Payment System. Access to the Bill Payment System may be
refused if any information is incomplete or incorrect.
After the completed form is received and approved by the Credit Union, access
will be given to the Bill Payment System. Notification and instructions will
be sent in writing to the address listed with the account given on this form.
| FEES:
|
Monthly Access Fee
|
FREE |
|
|
Non-Sufficient Funds (NSF)
|
$20.00
|
|
|
Courtesy Pay
|
$20.00
|
|
|
Stop Payment
|
$15.00
|
Signature: _______________________________________ Date: ___________
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