Community Financial Credit Union
Payroll Deduction/Direct Deposit Authorization Form

To sign up for payroll deduction, please complete the form below.  Once complete, print it, sign and date the bottom, and fax to us at 417.862.7802.
I hereby authorize my Employer to deduct from my salary the amounts set forth below and to deposit funds at the Credit Union for each payroll period following receipt of this 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.
Full Name: Account Number:
Employer: SSN/TIN:
Home Phone: Work Phone:
Payroll #:

Initial Authorization
Change in Authorization
Deposit Amount Net Check Payroll Period Weekly
$ Bi-weekly
Monthly
Credit Union R/T #: 286582779 Semi-Monthly

Member Signature __________________________________ Date___________

By signing above, I authorize Community Financial Credit Union to apply my payroll deduction for each pay period as follows:
Checking $
Share/Savings $
Investment Savings $
Loan # $
IRA $
Other $
Other $
Other $