Direct Deposit Form

Electric Cooperatives FCU Direct Deposit Form
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Please complete the direct deposit form and forward it to your payroll department for faster processing.

Authorization Code:

New

Change

Cancel
I authorize you and Electric Cooperatives FCU to initiate electronic credit entries,
and if necessary, debit entries and adjustments for any credit entries in error to my:

Checking Account #		$
Savings Account #		$

each pay period. This authority will remain in effect until I have cancelled it in writing.

Financial Institution Information

Account Holder Information

Financial Institution: Electric Cooperatives FCU

Name (Please print):

Address: 1 Cooperative Way

SS#:

City, State, Zip: Little Rock, AR 72209

Signature:

Employer Name:

Date:

Address:

City, State, Zip: