Payroll Deduction Authorization

Please complete this form, then print, and sign. Your signature (s) are required.
You can either mail this form to:
Creighton Federal Credit Union
2575 Dodge Street
Omaha, NE 68131-2602
or bring it in to any of our five convenient Creighton Federal offices.

Member Information
Name
Member #
Address
City
State
Zip
Please provide the following information:

Your Employer is:
Creighton University Bi-weekly
Creighton University Monthly
Alegent Health
College of Saint Mary
Creighton Prep High School
New Cassel Retirement Center
Current Deduction
Increase By
Decrease By
Total New Deduction
Please tell us to which savings, checking, retirement or loan account
you would like to direct your payroll deduction amount.

As of this date I authorize my payroll supervisor to deduct the following amount
from my pay check each pay period for my account at Creighton Federal Credit Union.
Signature
Date
Signature
Date
Due to varying payroll processing dates, your payroll deduction will be established as soon as possible,
but may not be effective with your next payroll date.