SSN Checking, account # Amount per month $ Savings, account # By signing this document, I hereby authorize my payroll office to make the continuing deduction shown aboveto Inspirus Credit Union and to make any necessary corrections.
This section is to be completed by the school payroll office if payroll is sent via manual check and
list.
Thank you!
11852.002 07/2015With payroll deduction, part of your paycheck is deposited eac...
Allowed
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