Northside FCU
Northside Federal Credit Union
 
PAYROLL DEDUCTION AUTHORIZATION FORM
Employee's Name _________________________
Department
___________________________
I hereby authorize Northside Hospital to make the following deduction from my paycheck each pay period for payment or deposit to the Northside Federal Credit Union.
 
SHARE DEPOSIT OR SAVINGS

   
$
  LOAN PAYMENT    
$
I hereby agree that upon written or verbal notification of my termination from the hospital, I authorize Northside to withhold all paychecks and monies due me and make whatever deductions are necessary to repay the full balance of my loan with the Credit Union.
Signature _________________________________________ Date ______________________
CREDIT UNION USE ONLY
  START
TOTAL DEDUCTIONS
$
CHANGE
ACCOUNT #
___________________________

You Must Print, Sign, and Mail to Credit Union
or Fax to 404-845-5033

 

 
 
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georgia credit unions
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