DIRECT DEPOSIT FORM
ACCOUNT NUMBER SSN DATE
NAME  ROUTING# PAYROLL NUMBER
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____________________________
You Must Print, Sign, and Return to Credit Union