Automatic ESA or IRA Contributions

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Form Instructions

Please complete, print, sign, and mail this form to:

Star One Credit Union
Attn: IRA Services
P.O. Box 3643
Sunnyvale CA 94088-3643

To submit this form electronically, log into Online Banking and select "IRA/ESA Automatic Contribution" in the "Forms" menu.

Please complete a separate form for each IRA contribution.

Your Information

Name:
Member Number (Transfer from):
Contribution type: Payroll Allocation, or Savings Allocation

Payroll Allocation

I want $ deducted from my regular paycheck each pay period and sent to the Credit Union to credit for 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event the company remits funds to the Credit Union in error, I am aware the funds credited to the IRA/ESA will not be withdrawn.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 #

Checking #

Into Contributory , account #

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.

Note: If you are not the IRA Owner or the Responsible Individual of the ESA authorizing this funds transfer contribution to this IRA/ESA, you will not have access to the funds deposited into the account.

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or supersedes any prior Credit Union deduction IRA/ESA authorization, and is to remain in effect until canceled or superseded by me in writing.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

___________________________________________
Member Signature

_______________________
Date

Daytime Phone:

Star One Credit Union use only
Processed By:
Date:
Audited By:
Date:

IRA/ESA Automatic Contribution

Form Instructions

Your Information

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