DIRECT DEPOSIT FORM
ACCOUNT NUMBER_________________________________________ DATE___________________________
NAME_____________________________________________________ SSN___________________________
LeTourneau Federal Credit Union ROUTING #
TO EMPLOYER:_____________________________________________
PAYROLL NUMBER:   
I hereby authorize you to deduct the following from my pay until further notice, and transmit to the above named Credit Union.
____MONTHLY ____SEMIMONTHLY ____BIWEEKLY ____WEEKLY
____NEW ____CHANGE ____STOP ____REALLOCATE
TOTAL DEDUCTION
EFFECTIVE DATE
CREDIT UNION EMPLOYEE
EMPLOYEE SIGNATURE______________________________________


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LeTourneau FCU
2301 S. High St.
Longview, Texas 75602
Fax: (903) 234-3486