Deduction Authorization Form - General Instructions
Have a question or need further assistance with completing the application?
Call Member Service at 1-800-288-6423 nationwide or 610-927-4000 in Reading, PA, or
Please report any change of address or employment status to the Credit Union. Since you may have Credit Union withdrawals sent directly to your home via U. S. Mail, a correct address is essential for prompt service.
This form serves as authorization for the employer to withhold Credit Union deduction from your salary. Please be advised that your employer may require additional paperwork to complete this transaction. Please contact your employer's HR/Payroll Department for specific instructions. This form also serves to notify the Credit Union of the desired distribution of the deduction.
You must sign the completed form to authorize the distribution of the deduction from your salary.
Note: If you are not changing the total amount of your deduction and just changing the distribution, you do not need to return the employer form.
indicate required information.
Member Account Information
Member Account Number:
Social Security Number:
Home Phone Number (with Area Code):
Work Phone Number (with Area Code):
Cell Phone Number (with Area Code):
Enter Date New Deduction Will Begin:
I have notified my employer's HR/Payroll Department