Credit Union Deduction Authorization Form

Credit Union Deduction Authorization Form
 NEW
 CHANGE
 STOP
Date:
To Entertainment Partners:
I authorize Entertainment Partners to deduct the following from my paycheck until written notification is
sent to terminate the voluntary payroll deduction. If monies to which I am not entitled are deposited to my
account, I authorize Entertainment Partners to direct the financial institution to return said funds and I
authorize the financial institution to act on Entertainment Partners direction and to return said funds:
Name:
SSN / Tax ID#:
Daytime Phone#:
Account #:
The Credit Unions that we deposit to are the following: (Select One Only)
1.
 CBS Credit Union
2.
 First Entertainment Credit Union
3.
 Musicians Interguild Federal Credit Union
4.
 NBC Employees Credit Union
5.
 Technicolor Federal Credit Union
6.
 Twentieth Century Fox Federal Credit Union
7.
 Universal City Studios Credit Union
SAVINGS
Deduct For: $
CHECKING
OTHER
$
$
OR
% of net check:
%
Total Deductions: $
 Savings
 Checking
Old Ded. Amt. $
Member Signature:
HAND SIGNATURE REQUIRED
Please Note: It is your responsibility to notify Entertainment Partners in writing when this account
becomes inactive.
Please send the completed form by fax to Employee Services at 818.848.0254 or by mail to
Entertainment Partners, Attn: Employee Services, P.O. Box 7836, Burbank, CA 91504-7836.
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Entertainment Partners | 2835 N. Naomi Street, Burbank, CA 91504-2024
Copyright © 2014 Entertainment Partners. All Rights Reserved. www.ep.com
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Revised 9/2014