NYC Partial Payroll Deduction Form

Employee / Member Information

*

Initial Deduction
Change in Deduction

Name

First Middle Last

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

(must be a street address; P.O boxes are not acceptable)

Employer's Name*

Employer's Address

Cell Phone Number

Home Phone Number

Social Security Number*

Work Phone Number

Date of Birth*

Reference/Employee Number*

Payroll #*

JSN

Email*

Code Word

Partial Payroll Deductions/Distributions Authorization

Member: Complete this section if you would like only a portion of your paycheck deposited in the Credit Union. If you would like full direct deposit of your payroll, log onto NYCAPS Employee Self Service (ESS) and complete with your Finest FCU account number and routing number 026084628.

Credit Union Checking Account Number

Amount to deposit to Credit Union Checking Account

Credit Union Savings Account Number

Amount to deposit to Credit Union Savings Account

Credit Union Loan Account Number

Amount to Deposit to Credit Union Loan Account

Signature

ENTER YOUR FULL NAME AS YOUR SIGNATURE*