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Payroll Deduction Auth/Change  -  Please Type in the Boxes, Print, and Sign   -   Please print two copies

 

Employee Name Account No.
Payroll No. Social Security No.

TO PAYMASTER:

I hereby authorize you to deduct the following amount from my pay:$each pay period OR until further notice from me and transmit same currently to the above named  CREDIT UNION.

StartChange           

Effective Date 
Employee Signature

 

 Date Signed

 

 

This deduction is to be credited as follows:  SHARES $ SHARE DRAFTS$ 

Loans $ Real Estate Loan $

 IRA Acct. $

Christmas Club $Vacation Club $ 

Other $

PAYROLL DEDUCTION INFORMATION

I understand that I have the choice of paying loans directly or by means of payroll deduction. I understand that if funds are accumulated (the second box blow is marked), I may withdraw them before they are credited to my loan account(s); but if I do that, I must make other arrangements to meet my scheduled loaned payment(s).

Under the credit union payroll deduction plan, funds are

credited to my account(s) immediately when received in identifiable form.

accumulated from each payroll and credited to my account(s)   

(credit union to specify time of crediting)

Member signature                                             

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revised 01/31/02