Payroll Deduction Direct Deposit - Credit Union of New Jersey
1301 Parkway Ave ? Ewing, NJ 08628 609-538-4061 ? 800-538-4061
Payroll Deduction Direct Deposit Authorization
EMPLOYER PAYROLL DEDUCTION AUTHORIZATION
Member Name:______________________________ Employer Name: ____________________________ Employer Address:__________________________ Phone Number:_____________________________
Member/Account Number:________________________ Social Security/Tax ID#:__________________________ Payroll Number:________________________________ Other:________________________________________
Initial Authorization
Change in Authorization
I hereby authorize my employer to deduct from my salary the amounts set forth below and to deposit these funds at the credit union for each payroll period following receipt of this authorization until further notice from me. If this is a change in a previous authorization, I instruct my employer to cancel my previous authorization and to follow this authorization. If I fail to cancel this authorization upon filing for bankruptcy, my employer and the credit union are directed to make and apply deductions in accordance with this authorization.
Deposit Amount or NET $
Payroll Period : CREDIT UNION R/T NO. 23127861-4
Weekly Biweekly Monthly Semi-Monthly
Signature X
Effective Date
CREDIT UNION DIRECT DEPOSIT AUTHORIZATION By signing above, I authorize the Credit Union to apply my payroll deduction
for each pay period as follows:
Share Savings: $__________________________ Share Draft/Checking: $____________________ Money Market: $__________________________ Club Account: $___________________________ IRA: $___________________________________
Loan ____: $__________________________ Loan ____: $__________________________ Other: $______________________________ Other: $______________________________ Other: $______________________________
CREDIT UNION COPY Cut Here
1301 Parkway Ave ? Ewing, NJ 08628 609-538-4061 ? 800-538-4061
Payroll Deduction Direct Deposit Authorization
EMPLOYER PAYROLL DEDUCTION AUTHORIZATION
Member Name:______________________________ Employer Name: ____________________________ Employer Address:__________________________ Phone Number:_____________________________
Initial Authorization
Member/Account Number:________________________ Social Security/Tax ID#:__________________________ Payroll Number:________________________________ Other:________________________________________
Change in Authorization
I hereby authorize my employer to deduct from my salary the amounts set forth below and to deposit these funds at the credit union for each payroll period following receipt of this authorization until further notice from me. If this is a change in a previous authorization, I instruct my employer to cancel my previous authorization and to follow this authorization. If I fail to cancel this authorization upon filing for bankruptcy, my employer and the credit union are directed to make and apply deductions in accordance with this authorization.
Deposit Amount or NET $
Savings Checking
Payroll Period
Weekly Biweekly
Monthly
Semi-Monthly
CREDIT UNION R/T NO. 23127861-4
Signature X
EMPLOYER COPY
Effective Date
................
................
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