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Star One Automatic IRA/ESA Contribution Election Form

Please complete, print, sign, and mail to Star One Credit Union, P.O. Box 3643, Sunnyvale, CA 94088-3643 Attn:  IRA Services.

Traditional Education Roth

Name: Member Number (Transfer from):

PAYROLL ALLOCATION
I want $ deducted from my regular paycheck each pay period and sent to the Credit Union to credit IRA/ESA Member Number account # . I understand these deductions will be credited to the IRA/ESA as current year contributions. I am also aware that the Credit Union is not responsible for insuring that contribution levels for the specified IRA/ESA does not exceed the limits set forth by the tax laws. I have authorized my employer, , to remit to Star One Credit Union, an amount from each of my regular paychecks for credit to the IRA/ESA Account. In the event the company remits funds to the Credit Union in error, I am aware the funds credited to the IRA/ESA will not be withdrawn. Any necessary correction for the amount will be removed from my regular savings account.

SAVINGS ALLOCATION
I authorize Star One Credit Union to transfer monthly $
from Member Number Savings #      or      Checking #
into Contributory Traditional IRA Roth IRA Education Savings Account (ESA) # .

I understand that these deductions will be credited to the IRA/ESA as current year contributions.

This authorization will be processed on the 5th of each month. In the event the Credit Union is closed, requests will be processed on the first business day following the 5th of the month.

Spousal IRAs

Funds transferred into a spousal IRA become the sole property of the IRA Holder. I have been advised by the Credit Union that I do not have any access to the funds deposited into the Spousal IRA Account indicated above.

This authorization cancels or supersedes any prior Credit Union deduction IRA/ESA authorization, and is to remain in effect until canceled or superseded by me in writing.

I understand all investments are deposited and accepted subject to all applicable federal and state laws and regulations of this organization presently existing or at any time hereafter issued. I authorize the contribution/investment of the IRA/ESA assets in the manner described above and certify that all of the information provided by me is correct and may be relied upon by the Custodian.


____________________________ Date Daytime Phone
Member Signature    

CREDIT UNION USE ONLY

Processed By:

________________________________
Audited By:

__________________________________
Date   Date  
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