Authorization Code: New Change Cancel
I authorize you and Air Guard Federal Credit Union to initiate electronic credit entries,
and if necessary, debit entries and adjustments for any credit entries in error to my:
Checking Account # |
 |
$  |
Savings Account # |
 |
$  |
each pay period. This authority will remain in effect until I have cancelled it in writing. |
| Financial Institution Information |
Account Holder Information |
| Financial Institution: Air Guard Federal Credit Union |
Name (Please print): |
| Address: 1701 N. Minnesota Ave. |
SS#: |
| City, State, Zip: Sioux Falls, SD 57104 |
Signature: |
| Employer Name: |
Date: |
| Address: |
| City, State, Zip: |