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.

Membership Account Number*

Amount to deposit to Savings Account

Amount to deposit to Checking Account

Amount to deposit to Loan Account

Amount to deposit to Holiday Club Account

Total amount to deduct each pay period*

Signature

ENTER YOUR FULL NAME AS YOUR SIGNATURE*