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(New Enrollments MUST include a voided check or (Fulton County Government)

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Signature: _____________________________________________ Date: ________________________
DEPARTMENT OF FINANCE
PENSION DIVISION
141 PRYOR STREET, S.W., SUITE
7001 ATLANTA, GEORGIA 30303
TELEPHONE (404) 612-7606
FAX:
(404) 612-1312
Retiree Name: ________________________________________________________________________
Last 4 of SSN: ________________________ Telephone #: __________________________
IN ORDER TO HAVE A DEDUCTION, YOU MUST HAVE AN ACTIVE ACCOUNT WITH THE CREDIT
UNION(S) BELOW.
I hereby authorize the Department of Finance of Fulton County, Georgia, to deduct from my pension check the
amount of $________ per paycheck until further notice and to pay amounts so deducted to the: (check one)
Excel Employees Credit Union [CRED2]
Routing Number: 261071548
Savings Account #: ______________________
Checking Account #: ______________________
This withholding represents: (check one)
*New Enrollment (MUST include voided check or bank verification for processing)*
An Increase
A decrease
Cancellation
Associated Federal Employees Credit Union [CRED1]
Routing Number: 261171338
Savings Account #: ______________________
Checking Account #: ______________________
This withholding represents: (check one)
*New Enrollment (MUST include voided check or bank verification for processing)*
An Increase
A decrease
Cancellation
AUTHORIZATION FOR CREDIT UNION DEDUCTIONS:
(New Enrollments MUST include a voided check or bank verification for processing.)
Atlanta City Employees Credit Union [CRED3]
Routing Number: 261071140
Savings Account #: ______________________
Checking Account #: ______________________
This withholding represents: (check one)
*New Enrollment (MUST include voided check or bank verification for processing)*
An Increase
A decrease
Cancellation
THIS FORM MUST NOT BE USED FOR DIRECT DEPOSIT/ NET PAY AMOUNT
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(New Enrollments MUST include a voided check or (Fulton County Government)

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Completed 17 July 2020

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