EFT Enrollment Form or Update Form
Bargaining Unit?
*
CCEA (Instructional)
CCAEOCAP (Non Instructional)
Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
*
Please enter a valid phone number.
Home Email Address
*
example@example.com
School Name
*
School ID Number
*
Date of Birth
*
Month/Day/Year Example: 01/01/1990
Authorization for EFT
I authorize the Association of my Membership, Collier County Education Association (CCEA) or Collier County Association of Educational Office and Classroom Assistant Personnel (CCAEOCAP), to initiate the scheduled membership payment each payroll period while school is in session from September through May to coincide with the CCPS payroll dates in the amount as annually certified by the said Association. If the payment date falls on a date that the bank does not process payments, the payment will be deducted on the next day that the bank does process payment. I agree to maintain sufficient funds in my deposit account to permit the automatic transfer described above.
Name on the account, if different than Member
Financial Institution Name
*
Routing No. (9 digits)
*
Banking Account No.
*
This authorization shall remain in full force and effect for all purposes while I am employed by this school district or until revoked by me.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Recruiter Name & School
This form has been encrypted to protect your sensitive information.
Continue
Continue
Should be Empty: