Account number at FSFCU: - First South Financial

Direct Deposit/Payroll Deduction Form

PLEASE PRINT

I, _______________________________________

, hereby authorize my Employer

(Employee/FSFCU Member name)

to create a new payroll deduction or make the following changes to my existing payroll deduction which is

deposited into my account at First South Financial Credit Union.

(Please check only one)

Start direct deposit of my NET PAY into my FSFCU account using the account number provided.

Start a new payroll deduction in the amount of $___________ and deposit the funds into the following

account number at FSFCU:

Change my existing deduction from $_________ to $__________.

Once your payroll deduction is deposited into your savings or checking account, FSFCU can automatically distribute the funds into more than one account. If you would like to set up an automatic distribution, please indicate below how you would like the funds distributed:

Savings $___________

Checking $__________

Christmas Club $__________

Vacation Club $__________

Employee Name: _________________________________

Phone # _________________

Social Security No: ___________________________ Date of Birth: _________________

Address: _________________________

City/State ____________________ Zip________

Employer: ________________________________ Employer Phone # _______________

Employer Address: ______________________ City/State ______________

Zip _______

Employee Signature:

Date: _________________

*************************************************************

For composite or individual check, please mail to:

For ACH/EFT Incoming Credits:

First South Financial Credit Union 6445 Stage Road Bartlett, Tennessee 38134

ABA Routing # 284085375

THANK YOU!

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