Direct Deposit Authorization

Save on your monthly service charges and non-Citizens-Union ATM fees.
Call or stop by your nearest branch and ask about our free Direct Checking account.

To set up Direct Deposit to your Citizens-Union Savings Bank Checking or Savings Account,
please print and complete the following form and submit it to your employer/funds originator with the following information:

This authorization form is valid only to direct funds to Citizens-Union Savings Bank.

I authorize _________________________ (Employer/Funds Originator) to initiate credit entries and, if necessary, to initiate any debit entries to correct an erroneous credit entry to my account at Citizens-Union Savings Bank.

Dollar amount: $_______ or Net pay

I understand that this authorization replaces any previous authorization and will remain in full force and effect until the company named above has received written notification from me of its termination in such time as to afford the company and depository a reasonable opportunity to act.

Citizens-Union Savings Bank

Account # __ __ __ __ __ __ __ __ __ __ __ __ __ (nine digits)

Your name (please print):

____________________________

Your signature:

____________________________

Date:

____________________________

Instructions for Employer/Funds Originator:

Please direct debit/credit entries of the above-named individual to:
Citizens-Union Savings Bank - Routing Number 2113 7223 9
4 South Main Street
P.O. Box 1311
Fall River, MA 02722-1311