Employer Payroll
Deduction Authorization
Please complete, print, and sign this form and give it to your employer, or ask your employer for a direct deposit form.

To allocate funds across several Star One accounts, make use of Online Banking's Scheduled Transfers and/or Cross Member Transfers.

Member/Employee Name: SSN/TIN:
 - -
Employer:
 		  Employee Number:
Phone (Home):
( ) - - 		Phone (Work):
( ) - -

Credit Union Routing Transit Number : 321177968
14 Digit Account Number
This is the 14 digit number that is MICR encoded on the bottom of your Credit Union checks. If you do
not have a checking account, contact the Credit Union at (866) 543-5202 or (408) 543-5202 for the
correct number.
PLEASE MARK ONE CHOICE IN EACH AREA BELOW        
This is:
Initial Authorization
Change in Authorization
 Deposit Amount:
Net Check
Fixed Amount (if available) $
Target Account:
Checking
Savings
Payroll Period:
Weekly   Semimonthly
Monthly  Biweekly

I hereby authorize my employer to remit to the Star One Credit Union for crediting to my account an amount from each of my regular paychecks determined by the option selected on this authorization. This authorization CANCELS and SUPERSEDES any prior authorization, and is to remain in effect until canceled or superseded by me in writing. In the event my employer remits funds to the Credit Union in error, I authorize the Credit Union to withdraw said funds from my account(s) and return said funds to my employer.

Note: Your Direct Deposit or ACH credit may not appear on the same date each month. Due to changes in processing at the Federal Reserve, such credits from the same originator may appear at the end of the month or at the beginning of the next month.

Signature: ________________________________________  Date:  _____________________