Fillable Direct Deposit Enrollment/Change Form

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Direct Deposit Enrollment/Change Form

On average this form takes 6 minutes to complete

The Direct Deposit Enrollment/Change Form form is 1 page long and contains:

  • 2 signatures
  • 9 check-boxes
  • 13 other fields

Country of origin: OTHERS
File type: PDF

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Direct Deposit Enrollment/Change Form
MEMBER INFORMATION (Please Print)
DEPOSIT 1
DEPOSIT 2
CHOOSE ONLY ONE:
CHOOSE ONLY ONE:
Name:
Company Name:
Name of Financial Instuon: UNIFY Financial Credit Union
PO Box 10018
Manhaan Beach, CA 90267
Name of Financial Instuon: UNIFY Financial Credit Union
PO Box 10018
Manhaan Beach, CA 90267
Roung & Transit Number: 322079719
Roung & Transit Number: 322079719
I authorize the above named company to deposit to my account(s) at UNIFY Financial Federal Credit Union dba UNIFY Financial
Credit Union (UNIFY) as indicated above. I acknowledge the right of this company to oset my future wages in the amount of any
overpayments the company may have deposited to my account.
Employee Signature:
Representave Name (Print)
CU 100-401 Rev. 07/16
Signature
PLEASE RETURN COMPLETED FORM TO YOUR EMPLOYER
Telephone Number Date
Date:
Social Security Number:
Check One:
You may choose up to two accounts at UNIFY Financial Credit Union to receive your deposits.
Enrollment
Savings Account #:
Savings Account #:
Amount to deposit in selected account:
Amount to deposit in selected account:
- -
$
$
or
or
NET
NET
$
$
Checking MICR*#:
Checking MICR*#:
*Checking MICR= The set of 11 or 13 digit numbers listed on the boom of your check aer the roung numbers (322079719). This number may or may not
contain your savings (member) account number.
*Checking MICR= The set of 11 or 13 digit numbers listed on the boom of your check aer the roung numbers (322079719). This number may or may not
contain your savings (member) account number.
Cancel Change
Employee Number:
Date:
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Direct Deposit EnrollmentChange Form

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Completed 30 November 2020

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