PAYROLL DEDUCTION FORM:Members, to start or change your payroll deduction :
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It's that simple!
502 Ninth Ave Fairbanks, Alaska 99701-4902 * Phone 907-452-3371 * Fax 907-452-6953
SOCIAL SECURITY # __ __ __ - __ __ - __ __ __ __ EMPLOYER______________________DEPT_________
_____ INITIATE PR DEPOSIT _____ CHANGE CURRENT PR DEPOSIT _____ DISCONTINUE PR DEPOSIT
Beginning the paycheck I receive ______________________ _____ DEPOSIT MY NET PAY OR
FOR BI-WEEKLY PAY PERIODS ( FNSB, FNSBSD, GVEA, GHU, ACS, AURORA ENERGY ):
I authorize you to deduct $________________ per pay period for all 26 pay periods per year.
FOR SEMI-MONTHLY PAY PERIODS ( CITY ):
I authorize you to deduct $______________ per month, half ($______________) from each paycheck.
I authorize my payroll department to deposit funds to which I am entitled into my account at City of Fairbanks FCU. The money will be credited to my account upon receipt from my employer. This authorization replaces any previous authorization and is in effect until cancelled in writing or upon rejection of a deposit by the credit union because the account is closed.
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Last modified: May 9, 2017
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