DIRECT DEPOSIT ENROLLMENT FORM(Print a copy, complete the form and submit it to your payroll department)

Name (First)                      (MI)             (Last)                                                           Social Security Number                                                                                                                                           -           -

Address                                                       City                       State                   Zip Code

I authorize ______________________ to initiate Direct Deposits to the Account indicated below.                                (Employer Name)

ACCOUNT INFORMATION

DEPOSITORY NAME                                                      ROUTING/TRANSIT NUMBER         PPL GOLD CREDIT UNION                                             231379131

TYPE OF ACCOUNT                    ACCOUNT NUMBER     AMOUNT OF DEPOSIT ___ checking  ___ savings                                                ___net pay  ___other $___________

SIGNATURE                                                                            DATE

Please be sure to notify PPL GOLD Credit Union prior to your first Direct Deposit.