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Er (if known): Employee Information Employee Name: Social Security Number: Daytime Phone Number: Banking Information Routing Number: Member Number: Type of Account: 322173055 Checking (Account # Savings (Member # ) ) TruWest Credit Union P.O. Box 3489 Scottsdale, AZ 85271 My signature below authorizes (employer) to electronically deposit my paychecks as I have instructed. They may also initiate debit entries to adjust any credit entries made to my account in error. This agreement remains.

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