Direct Deposit/ Payroll Deduction Form

Print this application and bring it to the credit union to request Payroll Deduction or Direct Deposit.

c Payroll Deduction or c Direct Deposit
Employer
______________________________________________________
I authorize my Payroll Department and Tri-Point FCU to deposit my net pay or portion thereof as indicated into my account each paydate.
If funds to which I am not entitled are deposited to my account, I authorize my Payroll Department to direct Tri-Point FCU to return said funds to my Payroll Department.
  c New c  Hourly
  c  Change c  Salary

Name (Print)
_____________________________________________________
Social Security Number
____________________________________________
Previous Deduction
$______________________________________________
Increase or Decrease Deduction
$____________________________________
TOTAL DEDUCTION
$_____________________________________________
Effective On Pay Date
____________________________________________
Tri-Point FCU Routing Number 243083512
_____________________________
Signature ___________________________________
Date _______________
This Is How I Want My Payroll Deduction Divided
Employer
_______________________________________________________
Effective On Paydate
______________________________________________
Print Name
______________________________________________________
Social Security Number
____________________________________________
Total Deduction or
Amount of Net Paycheck or Net Social Security
$_________________________
Is This Your Net Check?       o Yes       o No
ACCOUNT AMOUNT
Share Savings $
Checking $
Holiday Club $
Vacation Club $
Individual Retirement Account $
LOANS
Auto Loan ...Loan # _________________________ $
Unsecured ...Loan # _________________________ $
Home Equity ...Loan # _________________________ $
Other ...Loan #
_________________________		 $
*TOTAL Dollar Amount To Credit Union $
* These totals should agree

 

Signature __________________________________
Date ________________


We do business in accordance with the
Federal Housing Law and the Equal Credit Opportunity Act.