Once
completed, print it, sign and date the bottom, and fax to the Credit Union
at (617) 278-5890. Payroll deduction is subject to Credit Union approval.
Last Name:
First Name:
Social Security #:
Member Number:
I have this
day authorized my employer
to deduct $
from my wages.
EACH PAYROLL PERIOD
Weekly
Bi-Weekly
Semi-Monthly
Monthly
University Credit Union is
authorized, upon receipt of my payroll deductions, to apply these deductions
as follows:
Main Share (Savings):
$
Money Market Draft Account:
$
IRA:
$
Vacation Club:
$
Holiday Club:
$
Loan(s):
$
Checking Account:
$
Holding Account:
$
I understand that I
am to terminate payroll deduction in the same method in which I began it. I
wish to continue making my loan payments by payroll deduction until such
time as I decide to terminate that method as to future deductions, even in
the event of bankruptcy, and if I fail to so terminate, I request that
payments continue to be made voluntarily to the loan in accordance with my
pre-bankruptcy instructions.
Member Signature
________________________ Date______/_______/______
Credit Union Authorized Signature
__________________________
University Credit Union ● 846 Commonwealth Avenue ● Boston MA 02215
Phone: 617-739-7447 ● Member Service Fax: 617-278-5890 ●
Loan
Department Fax: 617-739-8346
Your savings federally insured to at least
$250,000 and backed by the full faith and credit of the
United State Government. National Credit Union Administration, a U.S.
Government Agency.
