Direct Deposit Payroll Request Form - OneAZ Credit Union
Direct Deposit Payroll Request Form
Instruction: Provide this completed form to your employer's payroll department. Your employer will do the rest.
To
Employer/Organization Name Mailing Address
From
Member Name
RE: Change of Direct Deposit Routing
To Whom It May Concern: Please send my automatic direct deposit to OneAZ Credit Union using the ABA Routing Number and Account Number(s) below.
Checking Account
Account Number
Amount
Savings Account
Account Number
Amount
OneAZ Credit Union Information Physical Address OneAZ Credit Union, 2355 W Pinnacle Peak Road, Phoenix, AZ 85027
Routing Number
322172496
Signature
By signing below, I hereby authorize the organization indicated above to initiate the deposit of my funds to my OneAZ Credit Union account(s). This authorization will remain in effect until I provide written notice of change or cancellation to the originating organization.
Primary Printed Name
Date
Signature
Joint Printed Name (if applicable) Signature
Date
MO.4.1.002
Direct Deposit Payroll Request Form | Page 1 of 1
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