ACH Forms (Automated Clearing House)
The following forms are in PDF format. You may submit by printing and completing the form then faxing to
(615) 242-6112 or returning the form to your local branch.
If you have any questions or need assistance with the form, please call the ACH Department at
800-755-8828 ext 7632.
Revocation of ACH Debit Agreement
This form is used to permanently revoke/stop the ACH loan payment from another financial institution.
It is also used if you want to change your amount being debited or the financial institution you want to
use to have the funds debited for the loan payment.
ACH Debit Stop Payment Request
This is the form you will use if an ACH item has cleared your account and you would like to stop any
future payments from being deducted from your savings or checking account with TTCU.
ACH Origination Temporary StopThe first section or box on the form is used when you have completed an extension with a loan officer at
the Credit Union. The second section is used when you want to stop a debit for a loan payment from
another financial institution.
Authorization Agreement for ACH Debit Origination
This form is used when you want to set up a debit withdrawal from your account at another financial
institution. It is used to start or change information on a loan payment or if you would like to have
money sent to a TTCU savings or draft account.
Written Statement of Unauthorized Debits This is a two-page form used when you have an unauthorized ACH debit that has come out of your
account and you would like to attempt to get your funds back.
Debit Card Fraud
Statement of Fraudulent Transactions
This form is used when there have been unauthorized transactions on your account using
your Debit Card. Please list each merchant, amount, and date of transaction and return to
the Credit Union’s Fraud Specialist. You may fax the form to 615-242-6112 or mail it to
P.O. Box 22881, Nashville, TN, 37202-2881. The Credit Union's Fraud Specialist will contact you
once the form has been received, or you may call 1-800-622-2535 Ext. 7728. You may also
return the form to your local branch.
You will also need to report your Debit Card as lost or stolen to PSCU, our card
processor. They are available 24 hours a day at 1-800-449-7728.
Overdraft Opt-in Notice
This form allows us to authorize and pay debit card transactions that may overdraft your checking account.
Credit Card Forms
Automatic Credit Card Payment
Balance Consolidation Request
Blocked Countries List
Beneficiary Designation Form
Change of Address Request Form
This document explains what TTCU does with your personal information. A form is attached to the
first page for you to tear off, complete and mail back to us that allows you to limit us or our affiliates
from using your personal information for marketing purposes.
Wire Transfer Request
Incoming Wire Instructions