LAPEER COUNTY SCHOOL EMPLOYEES CREDIT UNION
PAYROLL DEDUCTION FORM
Last Name____________________________First_____________________Initial__________
Address_____________________________________________________________________
City_______________________Zip__________________Phone________________________
School District Name: Lapeer Intermediate School District School Name_________________
Your Classification________________________________
PLEASE DEDUCT FROM EACH PAY $ _______________________
To apply as follows:
Shares 00________________________
Shares 61______________________
Shares 62_______________________
Christmas Club 69_________________
Drafts 91________________________
Signature___________________________________ Date__________________ Account #____________
*Please complete and return to the Credit Union or Payroll Office.