Kerr County FCU
3700 Memorial Blvd
Kerrville, TX 78028

Fax: (830) 896-6804
PAYROLL DEDUCTION
DIRECT DEPOSIT
AUTHORIZATION
Employee Payroll Deduction Authorization
Member
Employer        
Home Phome    Work Phone
Member No:
SSN/TIN:
Payroll No:

Initial Authorization
Change in Authorization

I hereby authorize my employer to deduct from my salary the amounts set forth in this Authorization and to deposit these funds at the Credit Union for each payroll period following receipt of this Authorization until further notice from me. I understand that this Authorization is revocable. If this 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. I grant the Credit Union a power of attorney to increase or decrease the amount of my deduction upon my written or verbal request. This power of attorney only applies to a loan or credit extension for which the payment may vary. I authorize my employer to honor any payment change made under this power of attorney.

Deposit Amount: Net Check      $_____________________

Credit Union R/T No: ____________________________________________

Deposit to: Savings      Checking     Account No:___________

Payroll Period
Weekly
Biweekly

Monthly
Semi-Monthly

   _________________________________________________
   Signature
                                           Customer Copy

   ________________
   Effective Date
You Must Print, Sign, and Return to Credit Union
(by mail, fax or in person)
A signature is needed to complete the process