Lanier Federal Credit Union
LANIER
EMPLOYER PAYROLL DEDUCTION AUTHORIZATION
Member ___________________________  Member Acct No. _____________________
Employer ____________________________________ SSN/TIN _____________________
Home Phone ____________________________________ Payroll No. _____________________
Work Phone
____________________________________    
       
Initial Authorization Change in Authorization
       
I hereby authorize my Employer to deduct from my salary the amounts set forth below and to deposit these funds at the Credit Union for each payroll period following receipt of this Authorization until further notice from me. If this is a change in a previous Authorization, I instruct my Employer to cancel my previous Authorization and to follow this Authorization. If I fail to cancel this Authorization upon filing for bankruptcy, my Employer and the Credit Union are directed to make and apply deductions in accordance with this Authorization.
           
Deposit Amount Net Check  Payroll Period Weekly
     
  Biweekly
  $_______________   Monthly
        Semi-Monthly
Credit Union R/T No.
_______________________

X___________________________________________
Signature

______________________
Effective Date



CREDIT UNION DIRECT DEPOSIT AUTHORIZATION
By signing above, I authorize the Credit Union to apply my payroll deduction for each pay period as follows:
 
Share Draft/Checking
$ _________________________
Share/Savings
$ _________________________
Money Market
$ _________________________
Loan# _______________________________
$ _________________________
Loan# _______________________________
$ _________________________
IRA _________________________________  
$ _________________________
Other _______________________________
$ _________________________
Other _______________________________
$ _________________________
 
TOTAL $ __________________



You Must Print, Sign, and Mail or Fax to:

Lanier Federal Credit Union
3718 Mundy Mill Rd
Oakwood, GA 30566
(770) 503-1865 (fax)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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