Artesian City Federal Credit Union

DIRECT DEPOSIT FORM

ACCOUNT NUMBER

SSN

DATE

NAME

ROUTING #

PAYROLL NUMBER

ARTESIAN CITY FEDERAL CREDIT UNION

TO EMPLOYER:

I hereby authorize you to deduct the following from my pay until further notice, and transmit to the above named Credit Union.

MONTHLY	SEMIMONTHLY	BIWEEKLY	WEEKLY
NEW	CHANGE	STOP	REALLOCATE

TOTAL DEDUCTION

EFFECTIVE DATE

CREDIT UNION EMPLOYEE

Signature of Employee____________________________

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