Follow the steps to complete your enrollment form.

1. Click ‘Get Form’ button to obtain the form and open it in your editing platform.
2. Enter your social security number in the designated field at the top of the form to identify your records.
3. Specify the department or town you are associated with by writing it in the appropriate section.
4. Check one box to indicate your role — options include Fire, Police, Marshal, Constable, or Justice. This clarifies the context of your application.
5. Choose the action type by checking one box indicating whether this is a new enrollment, change, or termination of a previous option.
6. Fill in the financial institution name where you want your payments directed. This is your bank or credit union.
7. Input your account number in the appropriate space. Ensure this information matches your bank records.
8. Specify the account type by checking either Checking or Savings, as applicable to your financial institution.
9. Write the account name. For example, if it is a joint account, list both names: 'Mr. and Mrs. John Doe' or single account name like 'John Doe'.
10. Provide the financial institution's routing (ABA) number, which can be found on your checks or by asking your bank.
11. Attach a copy of a voided check to verify the accuracy of your account data, ensuring it is not a deposit ticket.
12. Sign and date the authorization section, confirming your request for the Department of Public Safety to direct your payments as specified.
13. Print your full name clearly in the designated block.
14. Include your daytime phone number for any necessary communication regarding your enrollment.
15. Fax the completed document along with the copy of the voided check to the designated number, 225-925-3973.

Complete your LA Direct Deposit Enrollment Authorization form online today!