National Council of Postal Credit Unions

Emergency Cash Network Share Account Withdrawal

I hereby request a withdrawl of from my share account  in the  Credit Union, whose address is for the following purpose:

I authorize said Credit Union to charge my share account a service fee of $5.00 for processing this advance. By my signature below, I acknowledge receipt of a cash advance in the above amount.

Signature of Credit Union Member   
Employee’s Name - Home Credit Union   
Employee's Signature - Disbursing Credit Union   
Name of Disbursing Credit Union   
Address of Disbursing Credit Union   

 

Mail or fax original to Home Credit Union

EXHIBIT "B"