Direct Deposit Authorization Form

Baltimore County Employees Federal Credit Union

Please complete the form on your screen, print it out, and submit to your employer. If your employer does not accept this form, please complete the correct form at your Payroll/HR Department.

Company Name / Employer:

I authorize the above listed entity to electronically deposit funds each payday to my Baltimore County Employees Federal Credit Union account listed below.

Member Account Number:

Direct Deposit Entire Amount:

Deposit entire amount to: Checking Savings

Direct Deposit Partial Amount:

Deposit partial amount to: Checking Savings

Deposit Amount ($):

Please use the following personal information and signature authorization. Contact me with any questions.

Name:

Social Security Number:

- -

Mailing Address:

Second Address Line:

City:

State:

Zip Code:

Home Phone Number:

- -

Daytime Phone Number:

- - X

X _______________________________________________________	____________________________
Member's Signature	Date

Contact your employer or income source to make sure no other special forms are required.

Baltimore County Employees Federal Credit Union
23 W. Susquehanna Ave., Towson, MD 21204
410-828-4730

ABA/Routing Number: 2520-7575-7