Payroll Deduction Form

There are two forms that need to be completed for a payroll deduction change. Make sure you scroll down and complete both forms.

1st page (Fill-in)

FirstEnergy Corp. Employee Payroll Deduction Form

		Account Number
		SAP Number
Name		I am paid:
				Check Payroll Frequency Below:
Location					Weekly
					Bi-Weekly
		Day Time Phone Number

This form is for FirstEnergy Corp. employees.

Please indicate the amount per paycheck you would like deducted and allocated to the following accounts. All deductions must be listed, not just current changes.

Type of Account	Account # & Suffix	Amount	Type of Account	Account # & Suffix		Amount
Savings			Loan
Savings			Loan
Savings			Loan
Savings			Loan
Christmas Club			Loan
Plan-it Save for it			Other__________
Plan-it Save for it			Other__________
Plan-it Save for it			Other__________
	Sub Total 1				Sub Total 2
Grand Total (Must Equal Sub Total 1 + Sub Total 2)

To FirstEnergy Corporation: I hereby authorize the FirstEnergy Family Credit Union to deduct from my pay the amount set forth above for transmittal to above named Credit Union as a credit to my account. This authorization cancels and supersedes any authorization heretofore signed by me and is to continue in effect until changed or cancelled by me in writing.

By signing the Payroll Deduction Allocation Form I understand that it is my responsibility to verify that all my deductions are posted properly. If any loan payments do not come out I understand that I am responsible for making the missed payment myself.

Signed By		Current Date

MAIL TO:	US Postal Address	FirstEnergy Corp. Interoffice mail code
	FirstEnergy Family Credit Union	A-FECU
	ATTN: PayRoll
	575 White Pond Drive, Suite E
	Akron OH 44320-1184

FirstEnergy

DIRECT DEPOSIT AUTHORIZATION - PAYCHECK AND EXPENSE REIMBURSEMENTS

FORM 91 (REV. 09-10)

EMPLOYEE NAME		SAP NO.
DAYTIME PHONE NO.	LOCATION	CHECK ONE WEEKLY BI-WEEKLY

AUTHORIZATION AGREEMENT

I authorize FirstEnergy Corp. to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries made in error to the account(s) listed below.

For verification of my bank account information, I have attached a voided check (not a deposit slip), a photocopy of a check, or I have contacted my financial institution for the correct routing number and account number.

This authorization will remain in effect until my written notification of cancellation or change is received. Direct deposit authorizations will be effective as soon as reasonably possible following receipt by Payroll Services.

PRIMARY ACCOUNT INFORMATION

	NEW	CHANGE IN EXISTING		CANCEL
FINANCIAL INSTITUTION NAME				CHECKING		SAVINGS
N/A
ROUTING NO.			ACCOUNT NO.
N/A
	EXPENSE REIMBURSEMENT ACCOUNT INFORMATION
NEW	CHANGE IN EXISTING	CANCEL		SAME AS PRIMARY ACCOUNT INFORMATION
FINANCIAL INSTITUTION NAME				CHECKING		SAVINGS
N/A
ROUTING NO.			ACCOUNT NO.
N/A
	OTHER ACCOUNT INFORMATION
	NEW	CHANGE IN EXISTING		CANCEL
FINANCIAL INSTITUTION NAME				CHECKING	FLAT AMOUNT
FirstEnergy Family Credit Union					$
				SAVINGS
ROUTING NO.			ACCOUNT NO.
241273104
	OTHER ACCOUNT INFORMATION
	NEW	CHANGE IN EXISTING		CANCEL
FINANCIAL INSTITUTION NAME	N/A			CHECKING	FLAT AMOUNT
					$
				SAVINGS
ROUTING NO.			ACCOUNT NO.
N/A
	OTHER ACCOUNT INFORMATION
	NEW	CHANGE IN EXISTING		CANCEL
FINANCIAL INSTITUTION NAME				CHECKING	FLAT AMOUNT
N/A					$
				SAVINGS
ROUTING NO.			ACCOUNT NO.
N/A
SIGNATURE						DATE

FOR PAYROLL SERVICES USE ONLY

DATE RECEIVED	DATE ENTERED	ENTERED BY