Lanier Federal Credit Union

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)