MUNICIPAL CREDIT UNION DIRECT DEPOSIT DISTRIBUTION REQUEST UMBER DEPOSIT ACCOUNT NUMBER a EMPLOYER SOCIAL SECURITY # PAYROLL GROUP TOTAL DEDUCTION TYPE ID $ 2,308.47 SHARE 02 WEEKLY BI-WEEKLY MONTHLY ACCOU 1D AMOUNT ACCOUNT! TYPE 1D AMOU $ $ ME | tors zz 91.00 $ $s $ $ $ $ $ $ $ is $ $ $ $ $ $ $ $ $ $ $ $ TOTAL DISTRIBUTION AMOUNT DATE | REP. $ 91.00 07/05/19 MAKEIDA ATWELL DAVID I authorize Municipal Credit Union to distribute the direct deposit of my payroll or US government payment as noted on this form. I understand that in order for the direct deposit of my paycheck or government payment to begin I must first complete and file a separate agreement with my employer or the appropriate government agency. If ever an incorrect amount should be deposited to my account(s). 1 authorize the Municipal Credit Union to make the appropriate adjustments. I also acknowledge receipt of the Electronic Funds Disclosure statement. NOTE: Any portion of a direct deposit not specifically designated for distribution to a particular account will be deposited in to the account you designated on the direct deposit authorization form. Signature: Date. 07/05/19 EFTA00124589