MUNICIPAL CREDIT UNION DIRECT DEPOSIT DISTRIBUTION REQUEST

MUNICIPAL CREDIT UNION DIRECT DEPOSIT DISTRIBUTION REQUEST ACCOUNT NUMBER DEPOSIT ACCOUNT NUMBER .111 EMPLOYER SOCIAL SECURITY 4 PAYROLL GROUP 000000 TOTAL DEDUCTION TYPE ID S 2,308.47 SHARE 02 WEEKLY x BI-W I.F.M.Y MONTHLY ACCOUNTS! TYPE ID AMOUNT ACC0UNT* TYPE ID AMOUNT LOAN 22 S 91.00 S S S S S S S S S S S S $ S S S S S S S S S S TOTAL DISTRIBUTION AMOUNT DATE REP. S 91.00 07/05/19 NAKEIDA ATWELL DAVID I authorize Municipal Credit Union to distribute the direct deposit of my payroll or US government payment as noted on this form. I understand that in order for the direct deposit of my paycheck or government payment to begin I must first complete and file a separate agreement with my employer or the appropriate government agency. If ever an incorrect amount should be deposited to my account(s). I authorize the Municipal Credit Union to make the appropriate adjustments. I also acknowledge receipt of the Electronic Funds Disclosure statement. NOTE: Any portion of a direct deposit not specifically designated for distribution to a particular account will be deposited in to the account you designated on the direct deposit authorization form. Signature: Date 07/05/19 EFTA00124589