Credit Union Payroll Deduction Form or Distribution of Direct Deposit
Please PRINT this page and fax it to your credit union at (203) 831-5833
| Social Security No. | ________________________________________________ |
| First Name: | ________________________________________________ |
| Last Name: | ________________________________________________ |
| Middle Initial: | ________________________________________________ |
| Company Name: | ________________________________________________ |
| Company Address: | ________________________________________________ |
| Work Phone: | ________________________________________________ |
I Elect: (Please check One)
| __ Payroll Deduction (Specific amount to Credit Union) | |
| __ Direct Deposit (Net Pay to Credit Union) | |
| __ Cancellation |
I am paid: (Please check One)
| __ Weekly | |
| __ Bi-Weekly (every two weeks) | |
| __ Monthly | |
| __ Bi-Monthly (15th and last day) |
Deduct from my pay each payroll period $__________ to be applied to the accounts as specified in the next section of this form.
Please distribute my deductions in the following manner: (Use R for remainder of Direct Deposit)
| Regular Share Savings (S1) | $____________ | ||||||||||||
| Share Draft Checking (S4) | $____________ | ||||||||||||
| Vacation Club (S7) | $____________ | ||||||||||||
| Christmas Club (S8) | $____________ | ||||||||||||
| Money Market Investment (S5) | $____________ | ||||||||||||
| IRA Money Management (S2) | $____________ | ||||||||||||
Family
Transfer:
|
|||||||||||||
Loan#________________________________....................$_____________
Loan#________________________________....................$_____________
Loan#________________________________....................$_____________