| FOR PAYROLL DEPARTMENT |
Name
(Send this form to your Credit Union.) |
_____________________________________ |
| Social Security Number |
_____________________________________ |
|
EDUCATIONAL & GOVERNMENTAL EFCU
|
| Payroll Supervisor of
the |
_____________________________________
(your employer) |
| I hereby authorize you to deduct ________________
dollars ($________), From my pay each payroll period,
until further notice from me, and transmit same currently
to the Educational & Governmental Employees Federal
Credit Union. |
| Date |
_____________________________________ |
| Signature of Employee |
_____________________________________ |
| For Office Use Only |
Payroll No.
|
Membership No.
|
| FOR CREDIT UNION |
Name
(Send this form to your Credit Union.) |
_____________________________________ |
| Social Security Number |
_____________________________________ |
|
EDUCATIONAL & GOVERNMENTAL EFCU
|
| I have this day authorized the Payroll Supervisor of
the |
_____________________________________
(your employer) |
to deduct from my pay each payroll period
until further notice $_________
to be transmitted to the credit union and credited as
follows: |
| Shares |
$____________________________________ |
| Share Drafts |
$____________________________________ |
| IRA Acct. |
$____________________________________ |
| Christmas Club |
$____________________________________ |
| Vacation Club |
$____________________________________ |
| Loans |
$____________________________________ |
| $____________________________________ |
| $____________________________________ |
| Other |
$____________________________________ |
| $____________________________________ |
| Total |
$____________________________________ |
| Date |
_____________________________________ |
| Signature of member |
_____________________________________ |
| For Office Use Only |
Payroll No.
|
Membership No.
|
