Payee/Joint Payee Certification:
I certify that I am entitled to the payment identified
above, and that I have read and understand this form. In signing
this form I authorize my payment to ACU to be deposited to the designated
account.
Signature______________________________________ Date_________
Signature - Joint Signer____________________________ Date_________
Financial Institution:
Alliant Credit Union
160 West Tenth Street
Dubuque, IA 52001-4848
Ph: 563-557-2229 Toll-free 800-928-4328
Routing Number: 273974633
ACU agrees to receive and deposit the payment identified above
in accordance with 31 CFR Parts 240, 209, and 210.
Cancellation:
The agreement represented by this authorization remains in effect
until canceled by you with your company/employer. Upon cancellation,
you should notify ACU that you are canceling. This agreement may
also be cancelled by ACU by providing you a written notice 30
days in advance of the cancellation date.
Change Receiving Financial Institutions:
Your direct deposit will continue to be received by ACU until
you notify your company/employer that you wish to change the financial
institution receiving the direct deposit. To effect this change,
you need to complete a new direct deposit form. It is recommended
that you maintain accounts at both financial institutions until
the transaction is complete, i.e. after the new financial institution
receives your direct deposit. |