Payroll Deduction Form for Web 092211.pub - E

Payroll Deduction (for employer)
Name: _________________________________
SSN:__________________________
Address: ______________________________________________________
Mbr #: ________________________________
City: _____________
State: ______
Zip: ___________
Home Phone: ________________________________________
Cell Phone: ________________________________________________
Company: ___________________________________________
Email: ____________________________________________________
Please check one:
New
Revised
Cancel
0.00
Total Deduction Amount: $_________________________
ABA Routing Number: 322079227
I hereby authorize my employer to deduct the amount shown each pay period and to pay the same to E-Central Credit Union for credit to my share
account. In the event of an error, I understand that my employer may reverse or adjust a deposit. This authorization cancels and replaces any
previous authorizations signed by me for this purpose and shall remain in effect until cancelled by me in writing.
Signature: ____________________________________________________________________________ Date: ______________________
E-Central Credit Union
Cut or tear here
● 990 S. Fair Oaks Ave., Pasadena, CA 91105
Phone: 626.799.6000 ● Fax: 626.799.6950
●
www.ecentralcu.org
Give this top half to your employer
Send this half to E-Central (see below)
Payroll Distribution (for E-Central)
Name: _________________________________
SSN:__________________________
Address: ______________________________________________________
Mbr #: ________________________________
City: _____________
State: ______
Zip: ___________
Home Phone: ________________________________________
Cell Phone: ________________________________________________
Company: ___________________________________________
Email: ____________________________________________________
Accounts
Amount
Membership Savings
$
Checking
$
Total Deduction Amount: $
0.00
Personal Savings
$
Money Market
$
I hereby authorize my employer to deduct the amount shown each pay period and to pay
the same to E-Central Credit Union for credit to my share account. In the event of an error,
I understand that my employer may reverse or adjust a deposit. This authorization cancels
and replaces any previous authorizations signed by me for this purpose and shall remain in
effect until cancelled by me in writing. Your payroll deduction will be distributed each pay
period as indicated to the left. Any remaining balance will be automatically deposited into
your Membership Savings. Loan payments are paid automatically each month by an electronic transfer from Membership Savings.
IRA
$
Signature: _________________________________________ Date: ______________
Holiday Club Savings $
E-Central Credit Union
● 990 S. Fair Oaks Ave., Pasadena, CA 91105
Phone: 626.799.6000 ● Fax: 626.799.6950
●
www.ecentralcu.org