Payroll Deduction/direct Deposit Allocation Authorization Form
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1PAYROLL DEDUCTION/DIRECT DEPOSIT ALLOCATION
AUTHORIZATION FORM
Initial Authorization
Change in Authorization
For questions with this form, please contact (212) 957-1055 ext. 1000 or 1021
MEMBER NAME
MEMBER NUMBER
SOCIAL SECURITY #
MEMBER ADDRESS
PAYROLL FREQUENCY
EMPLOYER NAME
WEEKLY
BIWEEKLY
MONTHLY
BIMONTHLY
TYPE OF ACCOUNT
ACCOUNT NUMBER
DIRECT DEPOSIT/ALLOCATION AMOUNT
SHARE DRAFT/CHECKING
#________________________________
$____________________ OR ______%
SHARE/SAVINGS
#________________________________
$____________________ OR ______%
VACATION CLUB
#________________________________
$____________________ OR ______%
HOLIDAY CLUB
#________________________________
$____________________ OR ______%
SIGNATURE LOAN
#________________________________
$____________________ OR ______%
AUTO LOAN
#________________________________
$____________________ OR ______%
OTHER
#________________________________
$____________________ OR ______%
OTHER
#________________________________
$____________________ OR ______%
By signing below or otherwise authenticating, I authorize the 1199 SEIU Federal Credit Union to apply my payroll deduction for each pay perios as indicated above.
X
_____________________________________________
____________
Signature of member
Date
PAYROLL DEDUCTION/DIRECT DEPOSIT ALLOCATION
AUTHORIZATION FORM
Initial Authorization
Change in Authorization
For questions with this form, please contact (212) 957-1055 ext. 1000 or 1021
MEMBER NAME
MEMBER NUMBER
SOCIAL SECURITY #
MEMBER ADDRESS
PAYROLL FREQUENCY
EMPLOYER NAME
WEEKLY
BIWEEKLY
MONTHLY
BIMONTHLY
TYPE OF ACCOUNT
ACCOUNT NUMBER
DIRECT DEPOSIT/ALLOCATION AMOUNT
SHARE DRAFT/CHECKING
#________________________________
$____________________ OR ______%
SHARE/SAVINGS
#________________________________
$____________________ OR ______%
VACATION CLUB
#________________________________
$____________________ OR ______%
HOLIDAY CLUB
#________________________________
$____________________ OR ______%
SIGNATURE LOAN
#________________________________
$____________________ OR ______%
AUTO LOAN
#________________________________
$____________________ OR ______%
OTHER
#________________________________
$____________________ OR ______%
OTHER
#________________________________
$____________________ OR ______%
By signing below or otherwise authenticating, I authorize the 1199 SEIU Federal Credit Union to apply my payroll deduction for each pay perios as indicated above.
X
_____________________________________________
____________
Signature of member
Date
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