<p> Authorization for Direct Deposit</p><p>To initiate direct deposit to your account at Blackhawk Community Credit Union please provide the completed the form to your payroll office or company sending the deposit. I wish to send my NET direct deposit to: Blackhawk Community Credit Union 2640 W. Court Street Janesville, WI 53547 Routing #275978048</p><p>Employee Name: Social Security #: BHCCU Account #: Deposit to my: Savings Account Checking Account </p><p>Employer/Payroll Office: Total Deposit Amount: $</p><p>Member Signature: ______</p><p>Date:______</p><p>I authorize the above listed employer/payroll office to initatite direct deposit in the amount listed above to Blackhawk Community Credit Union account. This Authority is to remain in full force and effect until my employer/payroll office has received written notification from me of its termination. I understand that it is my responsibility to notify my payroll office if any of the above information changes. </p>
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