PLEASE FILLIN THIS FORM COMPLETELY SIGN AND DATE WHERE INDICATED AND RETURN TO THE CREDITUNIONNAMESOCIALSECURITYNOADDRESSACCOUNTEMPLOYEE NOPENSION NOCITYEMPLOYMENTPHONE NOS WorkADDRESSHome do not wis ID: 885244
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1 Payroll/Pension Deductions PLEASE FILLIN
Payroll/Pension Deductions PLEASE FILLIN THIS FORM COMPLETELY; SIGN AND DATE WHERE INDICATED AND RETURN TO THE CREDITUNION.NAME:___________________________________________________SOCIALSECURITYNO.:_________________________________ADDRESS:_______________________________________________ACCOUNT/EMPLOYEE NO.:_______________________________________________________________________________________PENSION NO.:___________________________________________CITYEMPLOYMENT:____________________________________PHONE NOS.: Work:_____________________________________ADDRESS:_______________________________________________Home: ____________________________________ do not wish to change my deduction amount, only the way i is being allocated. (Show changes below.) wish to have my Federal Recurring Payment, ______________________________, sent to Credit Union of Atlanta and beallocated as indicated below. _____________________, I now have no outstanding loan obligations. ALLOCATION (show TOTALdeduction) OLL DEDUCTION AUTHORIZATION salary and pay same to the Credit Union of Atlanta. I authorize this deduction to be increased to cover scheduled pay-Signature:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date______________________________ Form 23 3/10