Revised 06/20/2011
Employee Name __________________________________________________
Employee ID ________________ Social Security Number ________________
Address _________________________________________________________
City ________________________ State ____________ Zip _____________
Contact Phone ____________________________________________________
Account Number ________________
___________________________ (employer)
_______________________ (date)
Signature __________________________________________________________
Name __________________________________________________________
Address ________________________________________________________
City ________________________ State ____________ Zip ____________
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
SECU Direct Deposit Authorization Form
Complete this form and take it to your Human Resources/Payroll office to initiate/change your Direct Deposit.
Employer Information
Employee Information
New Direct Deposit Information
State Employees’ Credit Union
Po Box 26748, Raleigh NC 27611
Routing Number 253177049
Authorization for Direct Deposit
I authorize to deposit my payroll check
directly to the account listed above effective .
