Mutual Security Federal Credit Union Forms

Credit Union Payroll Deduction Form or
Distribution of Direct Deposit

Social Security No.
First Name:
Last Name:
Middle Initial:
Company Name:
Company Address:
Work Phone:

I Elect:

	Payroll Deduction (Specific amount to Credit Union)
	Direct Deposit (Net Pay to Credit Union)
	Cancellation

I am paid:

	Weekly
	Bi-Weekly (every two weeks)
	Monthly
	Bi-Monthly (15th and last day)

Deduct from my pay each payroll period $__________ to be applied to the accounts as specified in the next section of this form.

Please distribute my deductions in the following manner:

(Use R for remainder of Direct Deposit)

Regular Share Savings (S1)

$____________

Share Draft Checking (S4)

$____________

Vacation Club (S7)

$____________

Christmas Club (S8)

$____________

Money Market Investment (S5)

$____________

IRA Money Management (S2)

$____________

Family Transfer:

	Account Number	Account Type
To:	____________	____________	$____________
To:	____________	____________	$____________

Loan#________________________________....................$_____________

Loan#________________________________....................$_____________

Loan#________________________________....................$_____________

Credit Union Payroll Deduction Form or Distribution of Direct Deposit

Credit Union Payroll Deduction Form or
Distribution of Direct Deposit