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Payroll Deduction
Employee Name: ____________________
Check One __ Texaco
__ Motiva
SS# ____________________
Check One __ New
__ Change
__ Cancel
Account Number ____________________
I hereby authorize Payroll to withhold from my pay: $___________________
  • 1st half pay period (15th)
 $___________________
  • 2nd half pay period (30th)
 $___________________
  • Each pay period
 $___________________
  • Shares
 $___________________
  • Loan
 $___________________
  • Christmas Club
 $___________________
Beginning date to pay the sum so deducted to: Petroleum Associates Federal Credit Union:

____________________
By submiting this form I agree to the aforementioned statements. This authorization supercedes all previous authoriztion for Payroll deductions

Signature of Employee:
______________________________


Please print out this form,
complete all information and mail it to:
                                    Main Office
                                    4127 Winters Chapel Rd.
                                    Doraville, GA 30360
OR Fax it to us at:
                                    Fax: (770) 936-4627