| ACCOUNT NUMBER_________________________________________ |
DATE___________________________ |
| NAME_____________________________________________________ |
SSN___________________________ |
| The Wright Credit Union |
ROUTING # 261173514 |
| TO EMPLOYER:_____________________________________________ |
|
| I hereby authorize you to deduct the following from my pay until further notice, and transmit to the above named Credit Union. |
| ____MONTHLY |
____SEMIMONTHLY |
____BIWEEKLY |
____WEEKLY |
| ____NEW |
____CHANGE |
____STOP |
____REALLOCATE |
|
| TOTAL DEDUCTION |
| EFFECTIVE DATE |
| CREDIT UNION EMPLOYEE |
|
| EMPLOYEE SIGNATURE______________________________________ |
You Must Print, Sign, and Return to Credit Union
|
The Wright Credit Union
P.O. Box 238
Toccoa GA, 30577
Fax: (706) 886-0154 |