Payroll Deduction Authorization Form printable pdf download

Johnstown School Employees

Payroll Deduction

Federal Credit Union

738 Viewmont Avenue

Johnstown, PA 15905

Authorization Form

Phone: 8142556642

Website:

EMPLOYER AUTHORIZATION

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Initial Authorization

Change in Authorization

Name:

Account Number:

Employer:

Social Security #:

Home Phone:

Work Phone:

Payroll Number:

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Pay Period:

Weekly

Biweekly

Deposit Amount: $

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Monthly

SemiMonthly

Deposit To:

Savings

Checking

I hereby authorize my employer to deduct from my salary the amounts set forth in this Authorization and to deposit

these funds at the Credit Union for each payroll period following receipt of this Authorization until further notice from

me. I understand that this Authorization is revocable. If this is a change in previous Authorization, I instruct my

employer to cancel my previous Authorization and to follow this Authorization. If I fail to cancel this Authorization upon

filing for bankruptcy, my employer and the Credit Union are directed to make and apply deductions in accordance

with this Authorization. I grant the Credit Union a power of attorney to increase or decrease the amount of my

deduction upon my written or verbal request. This power of attorney only applies to a loan or credit extension for

which the payment may vary, I authorize my employer to honor any payment change made under this power of

attorney.

Signature

Effective Date

CREDIT UNION AUTHORIZATION

By signing above, I authorize the Credit Union to apply my payroll deduction for each pay period as follows:

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