PAYROLL DEDUCTION FORM: Members, to start or change your payroll deduction : 1. Print this page. 2. Fill out the form. 3. Turn it in to the payroll department where you work. It's that simple!

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

DIRECT DEPOSIT AUTHORIZATION TO CITY OF FAIRBANKS FEDERAL CREDIT UNION 502 Ninth Ave Fairbanks, Alaska 99701-4902 * Phone 907-452-3371 * Fax 907-452-6953 EMPLOYEE NAME__________________________________________________EMPLOYEE#____________ 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, CENTURY, 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. SIGNATURE______________________________________________________ DATE___________________ for Payroll Use Only TRANSIT ROUTING # 3252-7220-9 SAVINGS ACCOUNT NUMBER INFO# _ _ _ _ DATE RECD_______________ DATE ENTERED_________________ BY ______________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

BACK to the CoFFCU home page.

URL is http://www.mosquitonet.com/~coffcu/payroll.htm
Last modified: June 28, 2000
Copyright © 1998-2009 City of Fairbanks Federal Credit Union