MUNICIPAL CREDIT UNION DIRECT DEPOSIT DISTRIBUTION REQUEST

ACCOUNT NUMBER					DEPOSIT ACCOUNT NUMBER

NAME					EMPLOYER
SOCIAL SECURITY #					PAYROLL GROUP
					000000
TOTAL DEDUCTION					TYPE ID
$ 2,308.47					SHARE 02
WEEKLY			BI-WEEKLY			MONTHLY
ACCOUNT#	TYPE	ID	AMOUNT	ACCOUNT#	TYPE		ID	AMOUNT
	LOAN	22	$ 91.00					$
			$					$
			$					$
			$					$
			$					$
			$					$
			$					$
			$					$
			$					$
			$					$
			$					$
TOTAL DISTRIBUTION AMOUNT			DATE			REP.
$ 91.00			07/05/19			MAKEIDA ATWELL DAVID

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 07/05/19 EFTA00124589