DIRECT DEPOSIT AUTHORIZATION FORM
NON-GOVERNMENT PAYROLL USE
This form is for non-government payroll use only. Please use Form 1199A for government payroll and benefits.
Complete this form and submit it to your employer’s payroll department.
If your payroll or benefits provider prefers to use their own form, you can use this as a reference.
Member Name: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Street Address: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
City: ___________________________________________________________________________________________________________ State: __________________________________________ Zip Code: _____________________________________________________________
I authorize ___________________________________________________________________ (employer/company name)
to deposit my earnings into the PenFed account(s) specified above and, if necessary, to electronically debit my account(s)
to correct erroneous entries. I certify my account(s) allow(s) these transactions. Furthermore, I certify that the above
listed account number(s) accurately reflect(s) my intended receiving account(s). I agree that direct deposit transactions I
authorize comply with U.S. law. My signature below indicates that I am agreeing that I am the accountholder and I authorize
my employer/company to make direct deposits into the named account(s). I understand this authorization will remain in
eect until I modify or cancel it in writing.
Member Signature
x
Date
Form 1299 (09/19) © Pentagon Federal Credit Union, 2019
PenFed Routing Number:
256078446
PenFed
Account
Number*: _____________________________________________________________
c
Checking Account
c
Savings Account (check one only)
c
Net Pay
c
Allotment $_____________________________________________________
PenFed is federally insured by the National Credit Union
Administration (NCUA). The information in this form is
current as of September 2019 and is subject to change. Our
address, in accordance with NY Law, is 7940 Jones Branch
Drive, Tysons, VA 22102.
*
You can locate your PenFed account number by logging into your account on PenFed.org and clicking the eye icon to reveal the whole
account number, on your statements, or via penFed’s mobile app.
If you want a portion of your net pay to be disbursed to second PenFed account, please complete the below account
information, allotment and dollar amount.
PenFed Routing Number:
256078446
PenFed
Account
Number*: _____________________________________________________________
c
Checking Account
c
Savings Account (check one only)
c
Net Pay
c
Allotment $_____________________________________________________
