LAPEER COUNTY SCHOOL EMPLOYEES CREDIT UNION
PAYROLL DEDUCTION FORM
Last Name____________________________First_____________________Initial__________
Address_____________________________________________________________________
City_______________________Zip__________________Phone________________________
School Name: CHATFIELD
Your Classification________________________________
PLEASE DEDUCT FROM EACH PAY $_________________________
To apply as follows:
Shares________________________
Shares 61______________________
Christmas Club_________________
Drafts________________________
Signature______________________________ Date______________ Acct #_________