Eagle Federal Credit
Union
|
Louisiana State
Employees’ Retirement System | |
|
Name: |
Social Security
Number: |
|
Start
Date: |
Retirement Date: |
|
I hereby authorize the
State of Louisiana Retirement System to make monthly deductions from my
Retirement Benefits in the amount of $__________ until further notice and
remit same to Eagle Louisiana Federal Credit Union. SIGNATURE__________________________________DATE
____________ THIS FORM SUPERSEDES
AND REPLACES ALL OTHER AUTHORITY FOR THIS DEDUCTION. |
|
ACCOUNT
NAME |
ACCOUNT
NUMBER |
MONTHLY
DEDUCTION |
|
DEPOSIT
ACCOUNTS |
|
|
|
Share
Savings |
1 |
|
|
Share Draft
(Checking) |
|
|
|
Christmas
Club |
|
|
|
Individual
Retirement Acct. |
|
|
|
Other____________________ |
|
|
|
Other____________________ |
|
|
|
LOAN
ACCOUNTS |
|
|
|
Line of Credit
(Signature) |
|
|
|
VISA |
141 |
|
|
Automobile
Loan |
|
|
|
Christmas
Loan |
|
|
|
Mortgage
Loan |
|
|
|
Other____________________ |
|
|
|
|
|
|
|
TOTAL MONTHLY
DEDUCTION |
THIS FIGURE MUST
MATCH THE DEDUCTION AMT LISTED AT THE TOP OF THIS FORM |
$ |