MISSOULA COUNTY PUBLIC SCHOOLS -- PAYROLL DIRECT SIGN UP FORM

Name (please print)

SS#

Phone Number

Financial Institution Name         Montana Educators Credit Union

Address      2000 South Russell Street, Suite 1
                   Missoula, MT 59801
Phone Number        728-1034
Routing Number          092981658
Allotment of Dollars
Checking $__________ Account 010800__ __ __ __ __
Savings $__________ Account              __ __ __ __ __
Enter dollar amount to go to each account type
Enter "Full Net" for remainder of check

For Credit Union Use
$                             to
$                             to
$                             to
$                             to

By signing, I authorize Missoula County Public Schools 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
Second Prenote Date

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