| ACCOUNT NUMBER_________________________________________ |
DATE___________________________ |
| NAME_____________________________________________________ |
SSN___________________________ |
| Richmond Community Federal Credit Union |
ROUTING # |
| TO EMPLOYER:_____________________________________________ |
|
| I hereby authorize you to deduct the following from my pay until further notice, and transmit to the above named Credit Union. |
| ____MONTHLY |
____SEMIMONTHLY |
____BIWEEKLY |
____WEEKLY |
| ____NEW |
____CHANGE |
____STOP |
____REALLOCATE |
|
| TOTAL DEDUCTION |
| EFFECTIVE DATE |
| CREDIT UNION EMPLOYEE |
|
| EMPLOYEE SIGNATURE______________________________________ |
You Must Print, Sign, and Return to Credit Union
|
Richmond Community FCU
2048 Tobacco Road
Gracewood GA, 30812 |