Fillable Printable Direct Deposit Payroll Request Form - Arizona
Fillable Printable Direct Deposit Payroll Request Form - Arizona
Direct Deposit Payroll Request Form - Arizona
Direct'Deposit'Payroll'Req uest'
Take this completed application form to your employer’s
payroll department and your employer will do the rest.'
'
Date:'________ ____'
"
To:' _____________ ___________________________________________________________'
" Employer"Name"or"Organization"
"
" _____________ ___________________________________________________________"
" Street"Address" " " " """""""""City" " " """"""""State"" " Zip"
"
"
From:'_____________ ___________________________________________________________"
" Name"on"Account"
"
"
RE:'Change'o f'D irect'Deposit'Routin g'
"
Please"s end"my"automatic"direct"depos it"to:"
"
Arizona"State"Credit"Union"
2355"W."Pinnacle"Peak"Road"
Phoenix,"AZ"8 5027"
" " " " "
Routing'Number:"322172496""
"
'Savings'Account'Number:'__________" " Amount:'$_________ _"
"
'Checking'Account'Number:'__________"" Amount:'$_________ _"
"
"
Please"remit"the"funds"via"ACH"to"Arizona"State"Cre dit"Uni on"(AZSTCU)"using"the"ABA"Routing"
and"selected"account"number"noted"above."
"
I"hereby"authorize"the"orga nizatio n"above"to"initiate"deposit"of"my"funds"to"my"AZSTCU"
account(s)."This"autho rization"will"remain"in"full"force"and"effective"until"I"provide"wr itt en"notice"
of"change"or"cancellation"to"the"originating"organization."
"
"
_____________ ______________________" " _____________ _______________________"
Signature" " " " " " "Date"
Automatic) Payment)Change)Form
Fill out one Automatic Payment Change Form for each automatic
payment you currently have scheduled and send to each company.
)
Date:)_________ _______" _____________ _____________________________"
Current"Accoun t"Number"
"
To:) _____________ ___________________________________________________________)
" Name"of"Company"making"autom atic"withdrawal"or"payment"
"
" _____________ ___________________________________________________________"
" Street"Address" " " " """""""""City" " " """"""""State"" " Zip"
"
From:)_____________ ___________________________________________________________"
" Name(s)"on"Accoun t"
"
" _____________ ___________________________________________________________"
" Name(s)"on"Accoun t"
"
" _____________ ___________________________________________________________"
" Name(s)"on"Accoun t"
"
" _____________ ___________________________________________________________"
" Street"Address"
"
" _____________ ___________________________________________________________"
" City,"State,"Zip"Code" " " """""""""""""""""""""""""""""" """"""""""""""""""""""""""Home"Phone"
)
To)Whom)It)May)Concern:"
Please"re direct"my" automatic"payment"for"the"above"accoun t"numb er"to"my"new"bank"account"as"instructed"b elow."
"
Account)Type:" "Checking"""""Account" #"____________ __""""""""""Savings"""""Account"#"______________"
"
Amount:) ) ))))))))))))))))))))))))))))$_________) ) ) ) ))))))))$_____ ____)
"
Effective:" "Immediately"" "Beginning"___/"___/"___"
"
Payment)Frequency:)______ ________ ________________)
)
My"New"Account"Info:"""Arizona)State)Credit)Union"
" " " 235 5"W."Pinnacle"Peak"Road"
" " " Phoenix,"AZ"85027"
"
Routing)Number:"322172496"
" "
"
If"you"have"questions"about"this"request,"please"contact"me"a t:""______________ ________ _____ ___"
"
_____________ ______________________" " _____________ _______________________"
Signature"" " " " " """"""""""""""""""Joint"Signature"(if"applicable)"
" "
_____________ ______________________" " _____________ _______________________"
Printed"Name" " " " " " Date"
Acco unt'Clos ure'R equest'
" " " Ensure all checks and transactions have
cleared be fore the account is closed.
'
'
Date:'________ ____'
"
To:' _____________ ___________________________________________________________'
" Former"Financial"Institution"
"
" _____________ ___________________________________________________________"
" Street"Address" " " " """""""""City" " " """"""""State"" " Zip"
"
From:'_____________ ___________________________________________________________"
" Name(s)"on"Accoun t"
"
" _____________ ___________________________________________________________"
" Name(s)"on"Accoun t"
"
" _____________ ___________________________________________________________"
" Name(s)"on"Accoun t"
"
" _____________ ___________________________________________________________"
" Street"Address"
"
" _____________ ___________________________________________________________"
" City,"State,"Zip"Code" " " " " " """""""""Home "Phone"
"
RE:'Notification'to'Close'Financial'Institution'Account'
"
I"hereby"aut horize"the"closure"of"my"account:"
"
Name"on"the"Account:"_________ ________ __________________ _____ ________ ________"
"
Closing"Accoun t"Number(s):"_____ ________ __________________ _____ ________ ________"
"
Effective:"_____________ ________ _________________________ _____ ______________"
"
I"certify"that"all"checks"have"cleared"the "account"to"be"closed"as"well"as"all"direct"deposits"and"automatic"payments"have"been"
stopped."By"signing"this"form,"I"authorize"yo u"to"release"the"remaining"funds"in"my"existing"accoun t"in"the"form"of"a"cashier’s"
check"made"payable"to"Arizona"State"Credit"Union"FBO"my"name:"
"
" Financial"Institution:"Arizona"St ate"Credit"Union" Routing"#:"322172496" Account"#:"______ ____"
" "
" Ari zona"State"Credit"Union"
" 2355"W."Pinnacle"Peak"Road"
" Phoenix," AZ"85027"
"
_____________ ______________________" " _____________ _______________________"
Account"Ho lder"Signature" " " " """"""""""""""""""Date"
"
_____________ ______________________" " _____________ _______________________"
Joint"Signature" " " " " """"""""""""""""""Date"
"
_____________ ______________________" " _____________ _______________________"
Joint"Signature" " " " " """"""""""""""""""Date"
