Direct Deposit Enrollment

Please complete the form below:

*Indicates a required field.

Financial Assurance Federal Credit Union ABA Number: 226077516
 

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DIRECTIONS
To arrange for a deduction from your pay check to go to your Financial Assurance Federal Credit Union account: (1) Complete & Submit the form below (Part 1) (2) Print out & Submit the Direct Savings Deposit (Part 2) to your payroll department.*IMPORTANT: Your Direct Deposit will not be completed if you do not complete this step. Where do I receive the Direct Savings Deposit Ticket (Part 2) to submit to payroll? The Direct Savings Deposit Ticket is a list of information automatically collected off of this completed form to compile information that is required to be received by your payroll department. It can be retrieved from either: A) The confirmation page you are redirected to after you hit "Submit" on this form.                                  OR B) The email you receive after you submit this form (being that a valid email address is provided)
MEMBER INFORMATION
First Name	*
M.I.
Last Name	*
Social Security Number [9-18]	*
Transit Number:                                                                 226077516
Business Phone Number	*
Company Name	*
Email Address	Please provide a valid email address if you would like a copy of the Direct Savings Deposit Ticket (Part 2) mailed to you.
- - - - - - - - - - - - - - - - - - - - - - - - - - DISTRIBUTION TICKET - - - - - - - - - - - - - - - - - - - - - - - - - -
Loan
Loan 2
Loan 3
Share 1 Savings
Share 2 Checking
Holiday Club
Vacation Club
TOTAL DEDUCTION (Automated Field=Sum of Distributions)	*
When submitting your company's Direct Deposit Authorization [Part 2] your deduction to the Credit Union will appear as a Savings deposit only in the amount of the Total Deduction above. When the funds are received, we will distribute them according to the distributions entered above.
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ELECTRONIC FORM SUBMISSION AGREEMENT: By submitting this form I am verifying the following: 1. The above information entered has indeed been entered by myself, the account owner or joint owner, and that submission of this form gives full authority to conduct the above requested action. 2. I understand that I do have the option or right to submit this form in the paper form, which is available either through our website at www.fafcuny.org and/or upon request by contacting the credit union. 3. I understand that I exercise the right to withdraw consent to have records provided electronically, including any conditions, consequences, or fees associated with doing so. To withdraw consent I must submit written documentation with my request and verify receipt of its retrieval. 4. By entering my first and last name next to the Electronic Signature field, this stands as the equivalent of a handwritten signature. Therefore, by entering false or fraudulent information you are committing forgery and the same laws and penal action apply. * Yes, I agree to the terms and conditions of submitting this form Electronically as outlined in the guidelines above.
Electronic Signature (Print First & Last Name) *
Date *
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