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 __________________________
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.
Branch:
846 Commonwealth Avenue - Boston, MA 02215
