Toll-free 800-580-3300 P.O. Box 2097, Universal City, Texas 78148-2097 – 1 IKEA-RBFCU Parkway, Live Oak, Texas 78233

Direct Deposit and Account Authorization

Name:

Address:

City:

State:

Zip:

Phone:

Routing Number: 314089681

Account Number:

Account Type:

Form Request Reason:

Direct Deposit Employer:

Please begin direct deposit to the RBFCU account listed above.

Automatic Payment Authorization

I hereby authorize (creditor) to initiate monthly deductions

from my Randolph-Brooks account beginning on (MM/DD/YYYY) and

continuing each month thereafter. This authority will remain in effect until revoked in a written request by me. Savings accounts are subject to Reg D transfer limitations of six electronic transactions per month. Refer to your Membership and Account Agreement for additional information.

Member Signature & Date

SSN (if required, must be completed by member)