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Signature: _____________________________________________ Date: ________________________
DEPARTMENT OF FINANCE
PAYROLL & EMPLOYEE BENEFITS DIVISION
141 PRYOR STREET, S.W., SUITE 7001
ATLANTA, GEORGIA 30303
TELEPHONE (404) 612-7605, Option 3
FAX (404)612-2929
EMAIL: payrollunit@fultoncountyga.gov
Employee Name: _________________________________________ Employee ID: __________________
Department: _______________________________________ Telephone #: _____________________
IN ORDER TO HAVE A PAYROLL DEDUCTION, YOU MUST HAVE AN ACTIVE ACCOUNT WITH
THE CREDIT UNION(S) BELOW. PLEASE NOTE: IN MONTHS WHERE THERE ARE 3 PAYCHECKS,
THE DEDUCTION WILL NOT TAKE PLACE ON THE 3
RD
PAY DAY.
I hereby authorize the Department of Finance of Fulton County, Georgia, to deduct from my salary 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
