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Change Payroll Direct Deposit &/Or Automatic Payment
Please submit one application per deposit/withdraw payment.
*All information marked with an asterisk * is a required field.
Employer/Depositor Name or Auto Withdrawal Company
Please enter in name or company *
You are currently depositing MY ENTIRE PAYCHECK PART OF MY PAYCHECK OR You are currently withdrawing (amount) for my (what payment is for).
(account or other identifying number).
(when) from the following account below:
* Old Bank
* Bank Routing Number
* Account Number
Please stop making DEPOSITS WITHDRAWALS to that account and Instead SEND THEM TO WITHDRAW THEM FROM
Peninsula Federal Credit Union
Routing Number Account Number
If you have any questions about this request, please contact me during the
DAY EVENING at
Signature
* Name
* Address
* City, State Zip
Other Information your employer may need (SSN, Employee ID#, etc.)
Signature: ___________________________
Date: _____________________