Payroll Deposit Distribution Authorization

• Member Name
  OK Member Name is required
• E-mail
  OK E-mail is required
• Phone
  Optional OK Phone is required
• Account Number
  OK Account Number is required
• Employer
  OK Employer is required
• Questions
  OK Questions is required

• Please Select Account Types for Payroll Deposit Distribution

  • Loan Account
  • Share Account
  • Share Draft Account
  • Money Market Account
  • Sub Account
  OK Please Select Account Types for Payroll Deposit Distribution is required

Loan Accounts

• Loan #1 Account Number
  OK Loan #1 Account Number is required
• Loan #1 Dollar Amount
  OK Loan #1 Dollar Amount is required

• Would you like to add another Loan Account?

  • No
  • Yes
  OK Would you like to add another Loan Account? is required
• Loan #2 Account Number
  OK Loan #2 Account Number is required
• Loan #2 Dollar Amount
  OK Loan #2 Dollar Amount is required

• Would you like to add another Loan Account?

  • No
  • Yes
  OK Would you like to add another Loan Account? is required
• Loan #3 Account Number
  OK Loan #3 Account Number is required
• Loan # 3 Dollar Amount
  OK Loan # 3 Dollar Amount is required

• Would you like to add another Loan Account?

  • No
  • Yes
  OK Would you like to add another Loan Account? is required
• Loan #4 Account Number
  OK Loan #4 Account Number is required
• Loan #4 Dollar Amount
  OK Loan #4 Dollar Amount is required

Share Accounts

• Share #1 Account Number
  OK Share #1 Account Number is required
• Share #1 Dollar Amount
  OK Share #1 Dollar Amount is required

• Would you like to add another Share Account?

  • No
  • Yes
  OK Would you like to add another Share Account? is required
• Share #2 Account Number
  OK Share #2 Account Number is required
• Share #2 Dollar Amount
  OK Share #2 Dollar Amount is required

• Would you like to add another Share Account?

  • No
  • Yes
  OK Would you like to add another Share Account? is required
• Share #3 Account Number
  OK Share #3 Account Number is required
• Share #3 Dollar Amount
  OK Share #3 Dollar Amount is required

• Would you like to add another Share Account?

  • No
  • Yes
  OK Would you like to add another Share Account? is required
• Share #4 Account Number
  OK Share #4 Account Number is required
• Share #4 Dollar Amount
  OK Share #4 Dollar Amount is required

• Would you like to add another Share Account?

  • No
  • Yes
  OK Would you like to add another Share Account? is required

Share Draft Accounts

• Share Draft #1 Account Number
  OK Share Draft #1 Account Number is required
• Share Draft #1 Dollar Amount
  OK Share Draft #1 Dollar Amount is required

• Would you like to add another Share Draft Account?

  • No
  • Yes
  OK Would you like to add another Share Draft Account? is required
• Share Draft #2 Account Number
  OK Share Draft #2 Account Number is required
• Share Draft #2 Dollar Amount
  OK Share Draft #2 Dollar Amount is required

• Would you like to add another Share Draft Account?

  • No
  • Yes
  OK Would you like to add another Share Draft Account? is required
• Share Draft #3 Account Number
  OK Share Draft #3 Account Number is required
• Share Draft #3 Dollar Amount
  OK Share Draft #3 Dollar Amount is required

• Would you like to add another Share Draft Account?

  • No
  • Yes
  OK Would you like to add another Share Draft Account? is required
• Share Draft #4 Account Number
  OK Share Draft #4 Account Number is required
• Share Draft #4 Dollar Amount
  OK Share Draft #4 Dollar Amount is required

Money Market Account

• Money Market Account Number
  OK Money Market Account Number is required
• Money Market Dollar Amount
  OK Money Market Dollar Amount is required

Sub Accounts

• Sub Account #1 Account Number
  OK Sub Account #1 Account Number is required
• Sub Account #1 Dollar Amount
  OK Sub Account #1 Dollar Amount is required

• Would you like to add another Sub Account?

  • No
  • Yes
  OK Would you like to add another Sub Account? is required
• Sub Account #2 Account Number
  OK Sub Account #2 Account Number is required
• Sub Account #2 Dollar Amount
  OK Sub Account #2 Dollar Amount is required

• Would you like to add another Sub Account?

  • No
  • Yes
  OK Would you like to add another Sub Account? is required
• Sub Account #3 Account Number
  OK Sub Account #3 Account Number is required
• Sub Account #3 Dollar Amount
  OK Sub Account #3 Dollar Amount is required

• Would you like to add another Sub Account?

  • No
  • Yes
  OK Would you like to add another Sub Account? is required
• Sub Account #4 Account Number
  OK Sub Account #4 Account Number is required
• Sub Account #4 Dollar Amount
  OK Sub Account #4 Dollar Amount is required

• • By clicking this box, I hereby authorize United Equity Credit Union to distribute the requested payroll deposit into the requested accounts and/or loans that I have listed on this form.
  OK By clicking this box, I hereby authorize United Equity Credit Union to distribute the requested payroll deposit into the requested accounts and/or loans that I have listed on this form. is required
• OK is required