PDF DIRECT DEPOSIT AUTHORIZATION FORM - New Jersey

The Community Credit Union of Bergen & Passaic Counties

DIRECT DEPOSIT AUTHORIZATION FORM

Directions: Fill out this form electronically, print it and submit it to your payroll department.

40 W Century Road Paramus, NJ 07652 359 Main Street Hackensack, NJ 07601

66 Hamilton St Paterson, NJ 07505

Main #: (888) 55-GAFCU Fax: (201) 996-0738 24-hour Touch Tone Banking: (866) GET-CU24 On the web at

Date

To Whom It May Concern:

I authorize my employer,

, to make electronic

deposits to my Greater Alliance account(s) each payday using the information below:

Name of person entitled to payment (Last, First, MI) Address: Home Telephone Number:

Social Security Number: Work Telephone Number:

City, State, Zip:

Name and Address of Financial Institution:

Greater Alliance Federal Credit Union 40 W Century Road Paramus, NJ 07652

Member/Account Number:

Savings:

C Total Check

C Partial Check in the amount of $:

If you have any questions, you may contact me at

Thank you.

Routing Number:

2212-7587-6

Checking:

C Total Check

C Partial Check in the amount of $:

.

Signature

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