FAX TO:  716-636-3711    ATTN:  Nicki Grisanti    

AUTHORIZATION CERTIFICATE FOR RELEASE OF CREDIT UNION DATA

 

CompuSource Systems, Inc. ("we" or "us")                                                       Fax: (716) 636-3711

 

Credit Union Name: ______________________________________________________           ("you")


Whereas, you have authorized the use of your credit union backup by us for the purpose described below, and


Whereas, we have already obtained a copy of this data for Microfiche/CD-DocuFile/Off-Site Storage, or Member Statement Preparation.


Now therefore in furtherance thereof you agree to the release of this data to the Individual/Department listed below.


It is your responsibility to complete and return this form to Nicki Grisanti at our office, at which time the data will be forwarded to the party so listed.


Purpose of request for Credit Union Data:


(please circle all that apply)


Credit Union Out of Balance


Credit Union EFT Processor Change/Problem


Research Member Information


Disaster Recovery Test

CompuShare Program Testing


Print Credit Union Report(s)


Create NCUA Aires diskette(s)


Testing of New Equipment purchased by Credit Union

Other (please specify):






Please release the Credit Union backup data for the following month ending _____________________________


to the following Individual/Department: _______________________________________________________


Signed,


 

______________________________________________                          __________________________

Authorized Signature                                                                                                Date