LCTCSPR20 Ed 110707
LCTCS Centralized Payroll (PeopleSoft)
Direct Deposit Enrollment Authorization – Main Bank (Primary Account)
EMPLID Business Unit/Location
Action Type (one)
/ /NEW / /CHANGE / /TERMINATE THIS OPTION
PRIMARY ACCOUNT INFORMATION – MAIN BANK
DEPOSIT AMOUNT TO THIS ACCOUNT WILL BE EQUAL TO NET PAY LESS ANY DEPOSITS TO SECONDARY ACCOUNTS
FINANCIAL INSTITUTION NAME
FINANCIAL INSTITUTION ROUTING (ABA) NUMBER (Bank Key)
BANK ACCOUNT NUMBER
ACCOUNT NAME (Ex: Mr. and Mrs. John Doe, John or Jane Doe, John Doe)
ACCOUNT TYPE (one) (Bank Control Key)
/ / *CHECKING
(provide voided check or account verification)
/ / *SAVINGS
(obtain account # & ABA # from financial
institution)
* Account verification or completion of enrollment form by financial
institution will assure the accuracy of account data:
Signature from Institution: _____________________________________
Phone Number: ______________________________________________
(Print full name)
I
, ___________________________________________, authorize and request the Louisiana Community &
Technical College centralized payroll to direct my net pay check to the account at the financial institution I
designated above.
For any funds paid to me which are not due and owing to me, through a pre-note paper check or through
direct deposit, I hereby agree and authorize my appointing authority (employer) to adjust the amount next
due to me to correct the overpayment, or to recover amount overpaid by reducing my future payroll checks
so that the overpayment will be repaid or recouped within a reasonable number of months [not to exceed 12
months].
It is my responsibility to notify Human Resources, as appropriate, should any changes occur to account
specified. Considering all above conditions are met, this authorization remains in full effect until a
written, signed notification to terminate, or another signed form (LCTCSPR20) indicating termination of
this option is received from me and the
Louisiana Community & Technical College System Centralized Payroll has had reasonable opportunity to
act on the termination.
_________________________________ _____________________ ___________________
Signature Date
Phone where you can be
reached between 8:00 a.m.
and 4:30p.m.
*Institution requirements may vary. Contact your human resources representative if you have questions.
/ / CHECK HERE IF SECONDARY ACCOUNT FORMS ARE ATTACHED.
Direct Deposit Enrollment-Main Bank
Print Form
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