Forms

I (we) hereby authorize my employer*

and the financial institution at which the employer's payroll account is maintained to make periodic deductions from my paycheck as indicated below and transfer same via the Routing ABA number given below to the Phi Beta Sigma Federal Credit Union (PBSFCU).

Check one:*

I (we) hereby authorize my Bank/Financial Institution,*

to initiate credit entries and to initiate, if necessary debit and adjustments for any credit entries in error to my (our)(select one)*

and Phi Beta Sigma Federal Credit Union (PBSFCU) to credit and/or debit the same to such account.PBSFCU Account Number (if already established)

This authority is to remain in full force and effect until the Financial Institution/Company has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Financial Institution/Company and PBSFCU 30 days to act on it.