Company Copy

Date:……/………/……..

I hereby authorize 3M Canada Company to deduct from each pay the sum of

$...............................for deposit with the 3M Employees’ (Ontario) Credit Union

Limited. The deductions to start as soon as possible.

Employee Signature………………………………………….

Employee Number: ………………………………………….

Name………………………………………………………….

Please Print

Home Address…………………………………………………

Please Print

……………………………………………………………………………………………

Credit Union Copy

Date:……/………/………

I hereby authorize 3M Canada Company to deduct from each pay the sum of

$............................ for deposit with the 3M Employees’ (Ontario) Credit Union

Limited. The deduction to be applied as follows:

ACCOUNT TYPE…………………$......................

ACCOUNT TYPE…………………$......................

ACCOUNT TYPE…………………$.......................

ACCOUNT TYPE…………………$.......................

Employee Signature:………………………………..

Employee Number:……………………………Payroll Group W B M

Name:………………………………………………………….

Please Print

Home Address:…………………………………………………

Please Print