Direct Deposit/ Payroll Deduction Form

Print this application and bring it to the credit union to request Payroll Deduction or Direct Deposit.

c Payroll Deduction or c Direct Deposit
I authorize my Payroll Department and Tri-Point FCU to deposit my net pay or portion thereof as indicated into my account each paydate.
If funds to which I am not entitled are deposited to my account, I authorize my Payroll Department to direct Tri-Point FCU to return said funds to my Payroll Department.
  c New c  Hourly
  c  Change c  Salary

Name (Print)
Social Security Number
Previous Deduction
Increase or Decrease Deduction
Effective On Pay Date
Tri-Point FCU Routing Number 243083512
Signature ___________________________________
Date _______________
This Is How I Want My Payroll Deduction Divided
Effective On Paydate
Print Name
Social Security Number
Total Deduction or
Amount of Net Paycheck or Net Social Security
Is This Your Net Check?       o Yes       o No
Share Savings $
Checking $
Holiday Club $
Vacation Club $
Individual Retirement Account $
Auto Loan ...Loan # _________________________ $
Unsecured ...Loan # _________________________ $
Home Equity ...Loan # _________________________ $
Other ...Loan #
*TOTAL Dollar Amount To Credit Union $
* These totals should agree


Signature __________________________________
Date ________________

We do business in accordance with the
Federal Housing Law and the Equal Credit Opportunity Act.