Employee Direct Deposit Application - Lockport City School District
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2EMPLOYEE DIRECT DEPOSIT APPLICATION
Your signature below authorizes Lockport City School District to deduct the total amount(s) indicatied below from each
paycheck and to credit your account(s). All existing accounts will continue - you do not need to list those accounts with
no changes or deletions. For new new direct deposits , attach a preprinted deposit ticket or voided check from this new account
that shows account and routing numbers. Please allow 2 weeks for processing.
PLEASE DELETE/STOP ACCOUNTS NO LONGER TO BE USED
Employee Name
Employee Signature
Last Four Digits of Social Security Number
Effective Date
NEW ACCOUNT
Account Number
DELETE/STOP
Name of Bank
OR Remaining Pay
CHANGE AMT
Amount of Deposit
$
after all other direct deposits and deductions
REACTIVATE
Checking
Savings
*do NOT enter dollar amount here
NEW ACCOUNT
Account Number
DELETE/STOP
Name of Bank
CHANGE AMT
Amount of Deposit
$
OR Remaining Pay
after all other direct deposits and deductions
REACTIVATE
Checking
Savings
*do NOT enter dollar amount here
NEW ACCOUNT
Account Number
DELETE/STOP
Name of Bank
OR Remaining Pay
CHANGE AMT
Amount of Deposit
$
after all other direct deposits and deductions
REACTIVATE
Checking
Savings
*do NOT enter dollar amount here
PLEASE STAPLE VOIDED CHECK OR PREPRINTED DEPOSIT SLIP HERE*
*If you have a full page letter from your bank, please attach to the back of form
See reverse for list of approved Direct Deposit Banks and Credit Unions
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