Request for Direct Deposit

*Members please check with your employer or other depositor to see if they
require a special form or voided check from you.

Employee/Client Information:
Name:
Work Phone:
Home Phone:
Employee ID: (If applicable)
First Deposit Account Information:
Financial Institution:	Northwest Community Credit Union
Routing Number:	323276524
Account Number:
Account Type:	Checking   Savings
	Please Deposit $  or % of my net pay into this account.
Second Deposit Account Information:
Financial Institution:
Routing Number:
Account Number:
Account Type:	Checking   Savings
	Please Deposit $  or % of my net pay into this account.
Third Deposit Account Information:
Financial Institution:
Routing Number:
Account Number:
Account Type:	Checking   Savings
	Please Deposit $  or % of my net pay into this account.
Signature:
Signature:

Filled out on .
Print and mail to your employer or other source of income.