Direct Deposit Authorization Form - Teachers Federal Credit Union
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1102 Motor Parkway • Hauppauge, NY 11788
Tel: 631‐698‐7000 • Fax: 631‐696‐0116 •
Mail: P.O. Box 9005, Smithtown, NY 11787
Submit completed form to Member’s Business Payroll Office
Direct Deposit Authorization
New
Revised
Teachers Federal Credit Union
ABA Routing Number: 221475786
Primary Account Holder’s Name: _____________________________________________
Date: _____________________
Primary Account Holder’s Social Security: ______________________________________
Joint Account Holder’s Name: ________________________________________________
Joint Account Holder’s Social Security: _________________________________________
Employed By: _____________________________________________________________
Please indicate the amount to be deducted each pay period:
Net Pay
Flat Dollar Amount: $ _________________________
Please select ONE of the following TFCU accounts to which the designated funds will be deposited into:
Account Number:
ACH Code
Savings: ____________________________________
32
Share Draft: 1261_____________________________
22
(Must be entered using the 14 digit MICR # format from the bottom of your share draft)
Money Market: 12610009_______________________
22
(Must be entered using the 14 digit MICR # format from the bottom of your share draft)
Direct Deposit of the designated funds shall continue until:
I leave my employment
I change authorization by written notice to my employer, or
Cancellation of authorization by written notice to my employer
The request to deposit the designated funds indicated above will be credited to the one account type as per your authorization.
Once funds have posted to your Teachers Federal Credit Union account, you may authorize additional distribution of those funds
by any ONE of the convenient methods indicated below:
Via Online Banking: Click on the Transfers Button and Schedule a Recurring Transfer.
OR
By Completing a Payroll Distribution Authorization Form located at under
Resources>Document Center>Payroll Distribution Authorization. Mail completed and signed form to:
TFCU, P.O. Box 9005, Smithtown, NY 11787 Attention: Payroll Department
OR
A Financial Services Representative at one of our local branches can complete the form at your request
I hereby authorize my Payroll Department to deduct from my paycheck, each pay period, the amount indicated above and to
transfer this amount to Teachers Federal Credit Union.
Member Signature: _______________________________________
Staff Member: ____________________________________
Joint Member Signature: __________________________________
Branch: __________________________________________
PAY-02 (12/12)
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Parent category: Business