	1375 Virginia Drive, Suite 102 Ft. Washington, PA 19034 Phone 215-542-8211

Don't Forget!

It's Your responsibility to update the Funds Office with any dependent changes - Birth of a child, Change in Marital Status, etc.

Direct Deposit Authorization Form

I hereby authorize the International Union of Operating Engineers Pension Fund of Eastern Pennsylvania and Delaware to initiate electronic transactions to my account(s) at the financial institution(s) indicated below.

Please note that the percent (%) deposited must equal 100%

Deposit of Monthly Pension BenefitThe account listed below is my Checking Account. I request that

% of my net pension benefit be credited to this account.

Institution:

City	State		Zip Code
Transit/ABA Number:		Account Number:

The account listed below is my Savings Account. I request that

% of my net pension benefit be credited to this account.

Institution:

City	State		Zip Code
Transit/ABA Number:		Account Number:

Please note that you must verify both your ABA Number and your Account Number with your bank. Make sure you tell your bank branch that you are having funds electronically transferred. This may change the ABA Number that we are to use.

Signature:*____________________________ Date:______________

* Please Hand-sign this area and mail the form to the address above

Social Security No.:

(xxx-xx-xxxx)