LEYDEN CU DIRECT DEPOSIT FORM
Please complete and present the following form to your company payroll department to authorize automatic deposits or debits to be made to Leyden Credit Union through the Automated Clearing House (ACH):
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Name______________________________________________________________________________ Address____________________________________________________________________________ City / St / Zip________________________________________________________________________ Soc. Sec. # _________________________________________________________________________ Account Number(s)___________________________________________________________________ [ ] Savings [ ] Checking Leyden Credit Union ABA number: 271984285 |
| Company___________________________________________________________________________ Address____________________________________________________________________________ City / St / Zip________________________________________________________________________ |
I hereby authorize _____________________________, [Employer] to initiate credit entries (and if necessary, to initiate debit entries and adjustments for any entries in error) to my account and Leyden Credit Union to credit and/ or debit the same to such account.
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SIGNATURE DATE
LEYDEN CREDIT UNION l 2701 N 25TH AVE l FRANKLIN PARK, IL 60131
Phone 847-455-8440 l Facsimile 847-455-1245 l http://www.leydencu.org