UF Membership and Authorization Agreement for Debit (ACH) Pre-Authorized Payments.
I authorize UNI United Faculty to debit my account listed below, each month or year, as elected below, for the amount indicated for dues. I also authorize UNI United Faculty and Veridian Credit Union to make any adjustments for errors made in the course of such charges. I understand that the dues amount is a percentage of my base salary and may be adjusted annually. I elect not to receive notice of changes to the dues amount as a result of salary changes. I understand that UNI United Faculty will notify me of any other changes to dues structures at least 60 days before going into effect and I authorize UNI United Faculty to adjust the debit to my account following such changes without notice.
This authorization is
UNI Department: __________________________________________________________________________
Home Address: __________________________________City, State, Zip_____________________________
Campus Address:_____________________________________Campus Mail Code: ____________________
Email Address, Campus: ____________________________Personal: ________________________________
Financial Institution Name: __________________________________________________________________
ABA Transit/Routing Number (see back): _______________________________________________
Account Number: ________________________________Account Type: ___Checking Savings
Authorized Monthly Debit Amount [see back for calculations] not to exceed $650.
This authorization remains in full force and effect until United Faculty and Veridian Credit Union receive written notice of change from me in such time and manner as to afford reasonable opportunity to act on it. Notices of cancellation or change must be received 10 days prior to the next withdrawal date
Please return this for to the United Faculty Office, Xxxxxxxx 2053, CM 0513 or directly to your Department Liaison or a UF Officer.
TENURED OR TENURE-TRACK PROBATIONARY FACULTY:
Salary x .0075: ______________________________________________
___ spouse is also a member [Name ]
___ OR for probationary tenure-track faculty
Total: ______________ ________ [not to exceed $650]
Payment Schedule: ____10 month 12 month
____ Annually on September 1st
TOTAL : per month: _ _ _
TERM, TEMPORARY, EMERITUS, OR RETIRED FACULTY:
$120 TOTAL, Payment schedule:
___ 12 month
(indicate month): ___________
This form is for the sole purpose of deducting union dues. The financial information will be provided to Veridian Credit Union for purposes of initiating the charges but will otherwise be kept confidential in the locked offices of United Faculty. The financial information will not be released for any other purpose.
ROUTING NUMBERS FOR FINANCIAL INSTITUTIONS IN THE CEDAR VALLEY:
Xxxxxx’x State Bank, Waterloo/CF:
Xxxx Deere Employees Credit Union
Lincoln Savings Bank, Cedar Falls
Regions Bank, Iowa
UNI Credit Union
U of I Community Credit Union
U.S. Bank, All Iowa Locations except Council Bluffs:
Veridian Credit Union:
Xxxxx Fargo, Iowa branches
For institutions not on this list, just Google the name of your bank, location, and “routing number”