Dear LAUSD Employee,
The Los Angeles Unified School District continues working to become more environmentally friendly
and generate savings to be reinvested in our schools. Together, our efforts to find creative solutions will
make a great difference in the District’s overall financial future.
You can play an active part in this work by enrolling for automatic deposit of your paycheck into your
bank account (checking or savings). By doing so, you will not only help us with the goals above, but you
will benefit by instant access to your funds on payday.
To activate automatic deposit of your paycheck on each payday, follow these three easy steps:
1. Complete the authorization card below
2. Attach a voided check or a savings account statement
3. Mail to Payroll Administration at 333 South Beaudry Avenue (27
th
Floor), Los Angeles, CA
90017
Every time you receive your pay through automatic deposit instead of receiving a paper paycheck, you
help put twenty-five cents back into classrooms.
Thank you for helping the District and making a difference for our environment!
AUTOMATIC PAYROLL DEPOSIT AUTHORIZATION FORM
LOS ANGELES UNIFIED SCHOOL DISTRICT
EMPLOYEE
NUMBER ______________________________________________
10 11 12 13 14 15 16 17 18 FI MI LAST NAME
I HEREBY AUTHORIZE THE LOS ANGELES UNIFIED SCHOOL DISTRICT OR ITS AGENTS, TO INITIATE DEPOSITS (AND/OR CORRECTIONS TO PREVIOUS DEPOSITS) TO THE
FINANCIAL INSTITUTION INDICATED BELOW. THE INSTITUTION IS AUTHORIZED TO DEPOSIT AND/OR CORRECT THE AMOUNTS TO MY ACCOUNT. I MUST SUBMIT A NEW
AUTHORIZATION CARD IF I CHANGE OR CLOSE MY ACCOUNT. THIS AUTHORIZATION REPLACES ANY PREVIOUSLY MADE BY ME AND IS TO REMAIN IN EFFECT UNTIL I
SUBMIT A NEW AUTHORIZATION CARD. PLEASE ALLOW 1 TO 2 PAY CYCLES FOR AUTHORIZATION TO BE EFFECTIVE.
BANK NAME _____________________________ BRANCH __________________________ BANK PHONE NO.__________________________
CANCEL APD CHANGE ACCOUNT NUMBER CHECK BOX IF SAVINGS ACCOUNT
50 51
_______________________________ ____________________________ ___________________________________________
School or Office Date Employee’s Authorized Signature
Please forward this card to Payroll Administration, 333 South Beaudry Avenue, 27
th
Floor, Los Angeles, CA 90017. For Direct Deposit
please attach a voided check or savings account statement showing your account number.
DO NOT COMPLETE THIS SECTION - PAYROLL ADMINISTRATION USE ONLY
TRANSIT NO. ABA NO. ACCOUNT NUMBER INFORMATION
24 25 26 27 28 29 30 31 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
Form L-60-950 rev. October 2011
