Payroll Deduction Authorization

Exit Secure Application

Date:
Account Number:
   
First Name:
Middle Name or Initial:
Last Name:
Home Street Address:
City:
State:
 Zip:
Home Phone #:
Cell Phone #:
    
Work Street Address:
City:
State: Zip:
    
Share Account: $
Share Draft (Checking): $
Christmas Club: $
Vacation Club: $
Current Loan Payments: $
Total Deduction: $

The undersigned employee hereby authorizes Brown-Forman Corporation to deduct and pay the Brown-Forman Credit Union the amount stated above from each paycheck of the undersigned commencing with the next pay period. The amount to be deducted shall be credited and applied as follows:

  1. If the employee is not indebted to the Credit Union, the amounts shall be credited to the employee's share account for the purpose of investing in shares of the Credit Union;
  2. If , at any time, the employee is indebted to the Credit Union and has signed a Payroll Deduction Authorization form, the provisions of such assignments and authorization shall apply to deductions from the employee's paychecks in lieu of the provisions hereof;
  3. If, at any time, the employee is indebted to the Credit Union but has not signed any such assignment and authorization, the amounts deducted hereunder shall be applied to the payment of the entire principal of and interest on such indebtedness as it accrues, and
  4. If, at any time, the employee is in default with respect to such indebtedness or, irrespective of any default, if the employee is for any reason terminated, the entire balance of such share account shall be credited to the payment of such indebtedness and the shares, including any fractional share, evidenced by such account shall be cancelled.

The deductions herein authorized shall continue until the undersigned notifies the Credit Union in writing that the deductions are to be discontinued.

By submitting this form electronically, I agree to the terms and conditions as stated above.