Hellgate Elementary School -- Payroll Dierct Deposit Sign Up Form

Attach a Blank Deposit Slip or Voided Check for Each Account.

Name__________________________________________________________________

SS# ___________________________________________________________________

Financial Institution Name         Montana Educators Credit Union

Address (bank)____________________________________________________
If not in Missoula
 
Routing Number          092981658

 
Allotment of Dollars
Checking $__________ Account __________________
Savings $__________ Account __________________
Savings $__________ Account __________________
Enter dollar amount to go to each saving(s) account. If you want all of your check,
or the remainder after savings is withheld, to go to a checking, then enter "NET"
in checking.

Name on account (if other than payee)______________________

By signing, I authorize Hellgate Elementary to directly deposit my paycheck to the
financial institution and account(s) named.

 
Signature________________________________________________________
For Payroll Office Use only
First Prenote Date_________________________________________________
Anticipated Active Date_____________________________________________