Payroll Deduction Form |
There are two forms that need to be completed for a payroll deduction change. Make sure you scroll down and complete both forms.
Mail both printed forms to:
Interoffice Location:
Or
FirstEnergy Family Credit Union
Attn: Payroll
575 White Pond Drive, Suite E
Akron, OH
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Account Number |
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SAP Number |
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Name |
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I am paid: |
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Check Payroll Frequency Below: |
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Location |
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Weekly |
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1) Please indicate the amount per paycheck you would like deducted and allocated to the following accounts.
2) All share and loan deductions must be listed per pay, not just current changes.
Type of Account |
Account # & Suffix |
Amount |
Type of Account |
Account # & Suffix |
Amount |
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Savings |
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Loan |
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Savings |
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Loan |
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Savings |
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Loan |
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Savings |
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Loan |
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Christmas Club |
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Loan |
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Other__________ |
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Other__________ |
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Other__________ |
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Sub Total 1 |
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Sub Total 2 |
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Grand Total (Must Equal Sub Total 1 + Sub Total 2) |
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To FirstEnergy Corporation: I hereby authorize the FirstEnergy Family Credit Union to deduct from my pay the amount set forth above for transmittal to above named Credit Union as a credit to my account. This authorization cancels and supersedes any authorization heretofore signed by me and is to continue in effect until changed or cancelled by me in writing.
By signing the Payroll Deduction Allocation Form I understand that it is my responsibility to verify that all my deductions are posted properly. If any loan payments do not come out I understand that I am responsible for making the missed payment myself.
Signed By |
MAIL TO: |
US Postal Address |
FirstEnergy Corp. Interoffice mail code |
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FirstEnergy Family Credit Union |
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ATTN: PayRoll |
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575 White Pond Drive, Suite E |
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Akron OH |
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FirstEnergy
DIRECT DEPOSIT AUTHORIZATION - PAYCHECK AND EXPENSE REIMBURSEMENTS
FORM 91 (REV.
EMPLOYEE NAME |
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SAP NO. |
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DAYTIME PHONE NO. |
LOCATION |
CHECK ONE |
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AUTHORIZATION AGREEMENT
I authorize FirstEnergy Corp. to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries made in error to the account(s) listed below.
For verification of my bank account information, I have attached a voided check (not a deposit slip), a photocopy of a check, or I have contacted my financial institution for the correct routing number and account number.
This authorization will remain in effect until my written notification of cancellation or change is received. Direct deposit authorizations will be effective as soon as reasonably possible following receipt by Payroll Services.
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FINANCIAL INSTITUTION NAME |
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CHECKING |
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SAVINGS |
N/A |
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ROUTING NO. |
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ACCOUNT NO. |
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N/A |
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EXPENSE REIMBURSEMENT ACCOUNT INFORMATION |
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NEW |
CHANGE IN EXISTING |
CANCEL |
SAME AS PRIMARY ACCOUNT INFORMATION |
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FINANCIAL INSTITUTION NAME |
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CHECKING |
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SAVINGS |
N/A |
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ROUTING NO. |
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ACCOUNT NO. |
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N/A |
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OTHER ACCOUNT INFORMATION |
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NEW |
CHANGE IN EXISTING |
CANCEL |
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FINANCIAL INSTITUTION NAME |
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CHECKING |
FLAT AMOUNT |
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FirstEnergy Family Credit Union |
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$ |
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SAVINGS |
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ROUTING NO. |
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ACCOUNT NO. |
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241273104 |
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OTHER ACCOUNT INFORMATION |
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NEW |
CHANGE IN EXISTING |
CANCEL |
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FINANCIAL INSTITUTION NAME |
N/A |
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CHECKING |
FLAT AMOUNT |
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$ |
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SAVINGS |
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ROUTING NO. |
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ACCOUNT NO. |
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N/A |
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OTHER ACCOUNT INFORMATION |
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NEW |
CHANGE IN EXISTING |
CANCEL |
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FINANCIAL INSTITUTION NAME |
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CHECKING |
FLAT AMOUNT |
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N/A |
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$ |
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SAVINGS |
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ROUTING NO. |
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ACCOUNT NO. |
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N/A |
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SIGNATURE |
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DATE |
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FOR PAYROLL SERVICES USE ONLY
DATE RECEIVED |
DATE ENTERED |
ENTERED BY |
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