Fillable CreditUnionChgForm - PRIORITY FEDERAL

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CreditUnionChgForm - PRIORITY FEDERAL

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PRIORITY FEDERAL
CREDIT UNION PO BOX 10969
Russellville.AR 72612-0969
Fax: 479-SB0-8014
Web: www.pnontyfedaral.us
Email: priorityfederaf@cox-internet.com
PAYROLL DEDUCTION AUTHORIZATION / CHANGE FORM
To The Paymaster of:
Ref: Employee Name:
CU Account Number:
Social Security Number:
I hereby authorize you to deduct the following amount from my check:
$ Each _____ semi-monthly pay period,
________monthly pay period,
Beginning with the_______________________ payroll distribution, and continue until further
notice from me. And
,
please remit to the Priority Federal Credit Union.
This form supercedes all previous authorization/change forms
,
and is authorized per a request
by our Member on
(Rev 08/06)
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CreditUnionChgForm - PRIORITY FEDERAL

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Completed 17 March 2020

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