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Checking Direct Deposit Authorization

Instructions:

Complete this form, attach voided check, and return it to your processor.
(i.e., employer's payroll, retirement, or other miscellaneous disbursements)

Name:

Address:

City:

State:

Zip:
Social Security Number - -

To your processor:

Please deposit:

 a deduction in the amount of $
  my net amount
To Christian Community Credit Union

Primary Checking Account
Account Number: (See voided check)
Routing & Transit No. 322274831
I understand that the Credit Union has permission to reverse any funds to which I am not entitled.
 
Signature: X ________________________________________________________ Date:_______________

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ATTACH VOIDED CCCU CHECK IN THIS AREA