Direct Deposit Authorization

Fill out the form below to authorize direct deposit by your employer to your credit union account.

Please fill this form out in its entirety.

If done correctly, this form will capture your information and send it to your HR/Payroll Manager email address. Alternately, you may send the form to yourself, print it, and give to your HR/Payroll Manager.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter Email Confirm Email

Employee's COG Credit Union Account Number(Required)

If your account number is 4 digits, enter only 4. If your account number is 5 digits, enter 5.

Direct Deposit Amount(Required)

Please choose the amount or percentage of your paycheck to be deposited.

Entire Paycheck

Set Percentage of Paycheck

Set Dollar Amount

Percentage Amount Requested(Required)

Enter the percent of your paycheck you want deposited directly to Church of God Credit Union.

Set Dollar Amount Requested(Required)

Enter the set amount of money you wish to have deducted from your paycheck and deposited directly to your account. Use whole dollars (no cents). Minimum $10 required.

Account to deposit into

Checking (Share Draft)

Savings (Share)

Employer/Company Name(Required)

Email Copy of Form(Required)

Who should receive this form? Your company? Or do you wish the copy to be sent to you directly so that you may print or forward it?

Employer

Send to Me

Employer HR/Payroll Manager Email(Required)

Signature(Required)

Date(Required)

Direct Deposit Authorization

You are now leaving Pathway Credit Union