Member Info:Name* First Last Member #*Employer Name*Payroll Deduction AuthorizationAuthorization* I authorize the Formation Credit Union to distribute funds from my direct deposit listed above in the manner listed below. This Authorization replaces any now in effect.This is a _________ of my current authorization.* New Change Cancellation Share/SavingsS#___Share Draft/CheckingS#___LoanL#___LoanL#___LoanL#___Christmas ClubS#___Vacation ClubS#___IRAS#___OtherS/L#___OtherS/L#___Automatic Transfer AuthorizationAuthorization I authorize the Formation Credit Union to make the following transfer of funds:This is a _________ of my current authorization.* New Change Cancellation Frequency* Monthly Semi-Monthly Bi-Weekly Weekly Amount*Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Debited Account*Credited Account*SignatureDate MM slash DD slash YYYY Δ