EFTA00124588.pdf

MUNICIPAL CREDIT UNION DIRECT DEPOSIT DISTRIBUTION REQUEST ACCOUNT NUMBER DEPOSIT ACCOUNT NUMBER 1580663 NAME EMPLOYER ID MR CLYDE WASHINGTON SOCIAL SECURITY II PAYROLL GROUP 000000 TOTAL DEDUCTION TYPE ID S 1,086.12 SHARE 02 WEEKLY x BI-WEEKLY MONTHLY ACCOUNT. TYPE ID AMOUNT ACCOUNT'S TYPE ID AMOUNT LOAN 21 5 45.50 $ 5 $ $ $ $ $ $ $ $ $ $ $ 5 $ 5 $ $ $ $ $ $ $ TOTAL DISTRIBUTION AMOUNT DATE REP. I S 45.50 05/31/19 ARRION FLETCHER I authorize Municipal Credit Union to distribute the direct deposit of my payroll or US government payment as noted on this form. I understand that in order for the direct deposit of my paycheck or government payment to begin I must first complete and file a separate agreement with my employer or the appropriate government agency. If ever an incorrect amount should be deposited to my account(s). I authorize the Municipal Credit Union to make the appropriate adjustments. I also acknowledge receipt of the Electronic Funds Disclosure statement. NOTE: Any portion of a direct deposit not specifically designated for distribution to a particular account will be deposited in to the account you designated on the direct deposit authorization form. Signature: Date 05/31/19 EFTA00124588