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Home Forms & Applications Payroll Deduction for CSULA employees
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Payroll Deduction form (for CSULA employees)


To protect the confidentiality of personal financial information and signatures, Cal State L.A. Federal Credit Union requests that our members send applications via the following safe methods:
By Fax: Complete the information requested, then print out all pages of the application and fax to our secured number: 323-505-2613
By Mail: Complete the information requested, then print out all pages of the application and mail in a sealed envelope to Cal State L.A. Federal Credit Union 2445 Mariondale Ave, Los Angeles CA 90032
In Person: Bring the completed application to our office at the address above, and submit it confidentially to one of our specialists.
Please note:
This form is for Credit Union use. Do not submit this form to the CSULA Payroll office.
This form is used to record your preferences for the distribution of your deduction in your Credit Union account.

___ Start  ___ Change ___ Stop       Account Number: ______________________

Name: __________________________  Social Security Number: ________________________

Home Phone: _______________________ Work Phone: ________________________________

EMPLOYER: Cal State L.A. Only Send a total of $ _______________ each period to CSLA FCU.

 

Distribution:

ACCOUNT TYPE ACCOUNT NO. / SUFFIX $ AMOUNT
Savings _____________________ _________________
Checking _____________________ _________________
IRA _____________________ _________________
Holiday Saver _____________________ _________________

 

LOAN TYPE LOAN NO. / SUFFIX $ AMOUNT
Signature/LOC _____________________ _________________
Auto _____________________ _________________
1st T.D. _____________________ _________________
OTHER _____________________ _________________
TOTAL CSULA FCU _________________

 

Signature

X_______________________________________________________ Date:_____________
 
© 2012 Cal State L.A. Federal Credit Union
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