Merchant Information

Merchant Name

Merchant Suite/Dept #:

Merchant Street Address

Merchant City

Merchant State  

Merchant Zip

Merchant Phone 

Your Account Information 

Account Number with Merchant

Sharefax Account Number

Suffix to Charge

Day of Month* to Charge

*Must be at least five (5) business days prior to due date.

Bill Amt.  

Is payment amount the same each month? Yes No

• It is the responsibility of the Member to initiate recurring payments once the Merchant/Bill has been added.

• Sharefax Credit Union, Inc. is not liable for charges incurred for non-receipt of payment due to insufficient funds or delay in delivery by the U.S. Post Office. 

• There is NO FEE for this service!

Email Address

(To be notified, via e-mail, your form has been processed)

Full Name

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