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Direct Deposit Authorization

Thank you for allowing Lake City Bank to serve your financial needs. Print off this form, complete it, and present it to your employer to request Direct Deposit service. Your employer may or may not offer this service.

Please pick one of the following Lake City Bank direct deposit options, provided they are both made available by your employer:

I authorize ______________________________________(name of Employer) to initiate credit entries and, if necessary, to initiate any debit entries to correct an erroneous credit entry to my account at Lake City Bank. I desire that my full net pay be direct deposited to my Lake City Bank account.

I authorize ______________________________________(name of Employer) to initiate credit entries and, if necessary, to initiate any debit entries to correct an erroneous credit entry to my account at Lake City Bank. I desire that __________(indicate percentage) of my net pay be direct deposited to my Lake City Bank account.

I understand that this authorization replaces any previous authorization and will remain in full force and effect until the company named above has received written notification from me of its termination in such time as to afford the company and depository a reasonable opportunity to act.

Lake City Bank Account Number__________________________________

Lake City Bank Account Type____________________________________

ABA Routing Number: 074903719

Name (please print)____________________________________________

Address_____________________________________________________

City, State, Zip________________________________________________

E-mail Address________________________________________________

Phone Number_______________ Best Time to Call__________________

Signature_______________________________ Date__________________


Instructions for Employer Direct Deposit
Please make debit/credit entries of the above-named individual to:
Lake City Bank
Electronic Banking
P. O. Box 1387
Warsaw, IN 46581-1387

ABA Routing Number:  074903719

Questions? Call 1-888-522-2265  or  (574) 267-6144.

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