PAYROLL DEDUCTIONS FORM
If you wish to begin or change your credit union payroll deduction(s), complete this form. You must already have established your AHFCU account. Once completed and signed, this form must be mailed to:
Allied Healthcare FCU
P.O. Box 1428
Long Beach, CA 90801-1428 


NAME:       ACCT. #  
DEPT:       SS #     

                      I HEREBY AUTHORIZE 

my employer,  to deduct the 
following amount from my paycheck for Allied Healthcare Federal Credit 
Union. This reflects the TOTAL AMOUNT I wish sent to the Credit Union to 
be distributed by them to my various accounts.

          Start       Change     
		 
          TOTAL DEDUCTIONS AUTHORIZED $
          
DATE    SIGNATURE 

             FUNDS TO BE CREDITED TO MY ACCOUNT AS FOLLOWS

                              DISTRIBUTION

               SAVINGS        $              
               CHECKING       $
               HOLIDAY CLUB   $
               VACATION CLUB  $ 
               IRA            $
               PENNY'S PALS   $
               LOAN #         $
               LOAN #         $
               LOAN #         $
               OTHER          $
               OTHER          $
               OTHER          $

                     TOTAL    $


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